Renal function of bladder cancer patients after urinary diversion by ileal conduit in Rajavithi Hospital

Abstract

Objectives: Our objectives were to evaluate the long-term renal function after radical cystectomy (RC) and ileal conduit diversion (ICD) and to analyze year-by-year the estimated glomerular filtration rate (eGFR) and morphologic upper urinary tract changes. Materials and Methods: We retrospectively identified 214 patients who had undergone RC and ICD from 2012 to 2018, with regular postoperative follow-up visits. The eGFR was calculated using the Modification of Diet in Renal Disease equation at baseline and during follow-up. A renal function decrease was defined as a greater than 10 mL/min/1.73 m2 reduction in the estimated glomerular filtration rate. Results: The median follow-up period after RC was 24 months (range, 6-60 months). The median eGFR decreased from 64 mL/min/1.73 m2 (range, 9-125 mL/min/1.73 m2) to 61.5 mL/min/1.73 m2 (range, 8-125 mL/min/1.73 m2). A decline in renal function occurred during the first postoperative years (2.74 mL/ min/1.73 m2 and 3.95 mL/min/1.73 m2 in the first and second year, respectively), with a slight decrease in the subsequent years. The strongest predictor of an eGFR decline was CKD stage 1 or 2 (> 60 mL/min/1.73 m2). Urinary obstruction was diagnosed in 6 patients (2.8%). Among the patients who underwent prompt interventional treatment, we did not find any association with the eGFR decline. Conclusion: Patients with urinary ICD have a lifelong risk of chronic kidney disease. Regular monitoring of renal function and the morphologic upper urinary tract will permit early diagnosis and treatment of modifiable factors, avoiding irreversible kidney damage.