Abstract

Precise determination of glomerular filtration rate (GFR) is essential for the management of patients with muscle-invasive bladder cancer (MIBC). We aim to describe the early evolution of measured GFR (mGFR) after radical cystectomy and urinary diversion (RCUD) and to identify risk factors for GFR decline. GFR measurement using 51Cr-EDTA continuous infusion, estimated GFR (eGFR) from five published equations and renal scintigraphy with split renal function determination were performed before and 6 months after RCUD. Chronic Kidney Disease (mGFR < 60 mL/min/1.73 m2) and GFR stages were defined according to the KDIGO guidelines using mGFR. Twenty-seven patients (men 85%, median age 65, IQR 59; 68 years) were included. A total of 20 (74%) patients experienced significant mGFR decline at 6 months postoperatively. Median mGFR decreased from 84.1 pre-operatively (IQR 65.3; 97.2) to 69.9 mL/min/1.73 m2 (IQR 55.0; 77.9) 6 months after surgery (p < 0.001). Thirteen (48%) patients had a progression to a worse GFR stage. Of the 22 patients without pre-operative CKD, 5 (23%) developed post-operative CKD. Diabetes mellitus was more frequent in patients in the highest tertile of relative mGFR decline (44% vs. 11%, p = 0.02) and platinum-based adjuvant chemotherapy tended to be more frequently used in these patients (44% vs. 17%, p = 0.06). Importantly, pre-operative weight was independently and negatively associated with post-operative mGFR and with mGFR slope in multivariable analyses. In this prospective series, we demonstrated that early and significant mGFR decline occurred after RCUD and perioperative platinum-based chemotherapy, especially in patients with diabetes mellitus and overweight.

Highlights

  • Precise determination of glomerular filtration rate (GFR) is essential for the management of patients with muscle-invasive bladder cancer (MIBC)

  • We found a significant decrease in median estimated GFR (eGFR) between baseline and follow-up according to Cockroft-Gault (p = 0.002), MDRD (p = 0.004), chronic kidney disease (CKD)-EPI (p = 0.003), Janowitz (p = 0.003) and FAS equations (p = 0.003)

  • We prospectively investigated the evolution of measured GFR (mGFR) with a gold standard method for GFR measurement using 51Cr-EDTA continuous infusion

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Summary

Introduction

Precise determination of glomerular filtration rate (GFR) is essential for the management of patients with muscle-invasive bladder cancer (MIBC). We aim to describe the early evolution of measured GFR (mGFR) after radical cystectomy and urinary diversion (RCUD) and to identify risk factors for GFR decline. Preoperative weight was independently and negatively associated with post-operative mGFR and with mGFR slope in multivariable analyses In this prospective series, we demonstrated that early and significant mGFR decline occurred after RCUD and perioperative platinum-based chemotherapy, especially in patients with diabetes mellitus and overweight. Most series on long term renal function outcomes after RCUD that have been published used different methods for glomerular filtration rate (GFR) assessment as a substitute of direct GFR measurement, the need of directly measuring GFR in these patients has previously been highlighted. The main aims of the present study were to describe prospectively the evolution of mGFR using a gold standard method before and 6 months after RCUD and to identify risk factors for early-accelerated mGFR decline

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