MP42-12 HIGHER PREOPERATIVE EGFR IS A PREDICTOR OF WORSE RENAL FUNCTION DECLINE AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY

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You have accessJournal of UrologyCME1 May 2022MP42-12 HIGHER PREOPERATIVE EGFR IS A PREDICTOR OF WORSE RENAL FUNCTION DECLINE AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY Shirin Razdan, Benjamin Eilender, John Pfail, Mariely Garcia, Daniel Ranti, Shoshana Rosenzweig, Abolfazl Hosseini, Jari Radros, Reza Mehrazin, Peter Wiklund, and John Sfakianos Shirin RazdanShirin Razdan More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , John PfailJohn Pfail More articles by this author , Mariely GarciaMariely Garcia More articles by this author , Daniel RantiDaniel Ranti More articles by this author , Shoshana RosenzweigShoshana Rosenzweig More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Jari RadrosJari Radros More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Peter WiklundPeter Wiklund More articles by this author , and John SfakianosJohn Sfakianos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002608.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with muscle invasive bladder cancer or high risk noninvasive bladder cancer, renal function decline is a concern after radical cystectomy with urinary diversion. The pathophysiology of this decline is multifactorial, with subclinical acidosis and metabolic derangements from the diversion thought to contribute. It is unknown whether patients with baseline chronic kidney disease (CKD) are at increased risk of further decline in renal function. METHODS: We performed a retrospective review of two high volume robotic assisted radical cystectomy (RARC) centers between 2016-2020. Preoperative demographics and comorbidities were collected. Postoperative estimated glomerular filtration rate (eGFR) was calculated at 12 and 24 months to determine short-term rate in decline of eGFR. Absolute and percent changes in eGFR were calculated. RESULTS: There were a total of 555 patients who underwent RARC. Men comprised 76.2% of the cohort. Neoadjuvant chemotherapy was given in 31% of patients and adjuvant chemotherapy was given in 4.81% of patients. Higher preoperative eGFR (B -0.549, 95% CI -0.708 - -0.391, p<0.001) and presence of diabetes mellitus (B -15.414, 95% CI -24.820- -6.008, p=0.001) were significant predictors of eGFR decline at 12 months. At 24 months, presence of diabetes mellitus (B -11.799, 95% CI -21.816 - -1.782, p=0.021) and higher preoperative eGFR (B -0.621, 95% CI -0.796 - -0.446, p<0.001) were correlated with a steeper decline in eGFR. Higher preoperative eGFR was also predictive of upstaging to CKD3 or higher post operatively (OR 1.019, 95% CI 1.004-1.034, p=0.015). Intracorporeal diversion was protective, whereas presence of hypertension, diabetes mellitus, and higher preoperative eGFR predicted greater decline in eGFR. CONCLUSIONS: Patients with higher preoperative eGFR and diabetes are at increased risk of renal function decline post RARC at 12 and 24 months. This suggests that patients with risk factors for renal function decline, but otherwise normal renal function at baseline, are a particularly vulnerable population for progression to CKD after RARC and should be counseled and closely followed postoperatively for renal function deterioration. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e735 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shirin Razdan More articles by this author Benjamin Eilender More articles by this author John Pfail More articles by this author Mariely Garcia More articles by this author Daniel Ranti More articles by this author Shoshana Rosenzweig More articles by this author Abolfazl Hosseini More articles by this author Jari Radros More articles by this author Reza Mehrazin More articles by this author Peter Wiklund More articles by this author John Sfakianos More articles by this author Expand All Advertisement PDF DownloadLoading ...