PD43-05 CHANGE IN RENAL FUNCTIONS AND RISK OF CHRONIC KIDNEY DISEASE AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY AND URINARY DIVERSION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2018PD43-05 CHANGE IN RENAL FUNCTIONS AND RISK OF CHRONIC KIDNEY DISEASE AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY AND URINARY DIVERSION Tomoaki Terakawa, Ahmed Aly Hussein, Paul May, Zhe Jing, Youssef Ahmed, Derek Wang, Hijab Khan, Adam Hasasneh, Adam Cole, Omer Rana, Kevin Stone, Alicia Skowronski, Sierra Broad, Gurkamal Chatta, Qiang Li, and Khurshid Guru Tomoaki TerakawaTomoaki Terakawa More articles by this author , Ahmed Aly HusseinAhmed Aly Hussein More articles by this author , Paul MayPaul May More articles by this author , Zhe JingZhe Jing More articles by this author , Youssef AhmedYoussef Ahmed More articles by this author , Derek WangDerek Wang More articles by this author , Hijab KhanHijab Khan More articles by this author , Adam HasasnehAdam Hasasneh More articles by this author , Adam ColeAdam Cole More articles by this author , Omer RanaOmer Rana More articles by this author , Kevin StoneKevin Stone More articles by this author , Alicia SkowronskiAlicia Skowronski More articles by this author , Sierra BroadSierra Broad More articles by this author , Gurkamal ChattaGurkamal Chatta More articles by this author , Qiang LiQiang Li More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2117AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the dramatic increase in the utilization of robot-assisted radical cystectomy (RARC) and urinary diversion, a description of how kidney functions may be affected is yet to be defined. We aimed to describe the changes in renal function after RARC, and determine the risk factors associated with developing chronic kidney disease (CKD). METHODS Retrospective review of 450 patients who underwent RARC and urinary diversion between 2005 and 2016 was performed. Patients who had prior nephrectomy or were on dialysis prior to RARC were excluded from the study. Estimated glomerular filtration rate (eGFR) was computed using the Modified Diet in Renal Diseases (MDRD) formula prior to RARC, at 1, 3, 6, 12 months after RARC and at the last follow up date. CKD was defined as eGFR<45 ml/min/1.73m2. Patients were stratified according to the diversion type received (ileal conduits-IC vs neobladders-NB). Multivariate stepwise regression analysis was used to assess the risk factors for developing CKD. RESULTS ≥405 received ICs and 45 received NBs. IC patients were significantly older (70 vs 57 years, p<0.001), had higher Charlson Comorbidity index (CCI) (3 vs 1, p<0.001), and more ≥pT3 (47% vs 13%, p<0.001). They exhibited lower median preoperative eGFR (69 vs 82 mL/min/1.73m2, respectively, p <0.001) and lower median eGFR at the last follow up (57 vs 71 ml/min/1.73m2, p=0.007). On multivariate analysis, higher CCI (OR 1.33, 95% CI 1.09-1.64, p=0.006), lower baseline eGFR (OR 2.80, 95% CI 1.55-5.06, p<0.001) and postoperative ureteral obstruction (OR 5.80, 95% CI 3.11-10.82, p<0.001) were associated with CKD after RARC. The risk of CKD increases with time after surgery for all patients (adjusting for baseline kidney function and CCI); In the first year following cystectomy CKD rates rose from 19% to 29% for IC patients, and from 5% to 12% for NB patients. CONCLUSIONS Preoperative lower eGFR, CCI and postoperative ureteral obstruction were independent risk factors for CKD after RARC. The risk of CKD increases over time for all patients and is more notable in IC patients, likely because of higher CCI and lower baseline eGFR rather than the type of diversion itself. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e878 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Tomoaki Terakawa More articles by this author Ahmed Aly Hussein More articles by this author Paul May More articles by this author Zhe Jing More articles by this author Youssef Ahmed More articles by this author Derek Wang More articles by this author Hijab Khan More articles by this author Adam Hasasneh More articles by this author Adam Cole More articles by this author Omer Rana More articles by this author Kevin Stone More articles by this author Alicia Skowronski More articles by this author Sierra Broad More articles by this author Gurkamal Chatta More articles by this author Qiang Li More articles by this author Khurshid Guru More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...