Renal Morbidity Following Radical Cystectomy in Patients with Bladder Cancer

Abstract

BackgroundPatients with chronic kidney disease (CKD) are poor candidates for standard treatments for muscle-invasive bladder cancer (MIBC) and may be more likely to experience adverse outcomes when diagnosed with MIBC. ObjectiveTo investigate factors associated with the development of advanced CKD following radical cystectomy. Design, setting, and participantsUsing national Veterans Health Administration utilization files, we identified 3360 patients who underwent radical cystectomy for MIBC between 2004 and 2018. Outcome measurements and statistical analysisWe examined factors associated with the development of advanced CKD (estimated glomerular filtration rate [eGFR] of <30 ml/min/1.73 m2) after radical cystectomy using multivariable logistic and proportional hazard regression, with and without consideration of competing risks. We examined survival using Kaplan-Meier product limit estimates and proportional hazard regression. Results and limitationsThe median age at surgery was 67 yr and the mean preoperative eGFR was 69.1 ± 20.3 ml/min/1.73 m2. Approximately three out of ten patients (n = 962, 29%) progressed to advanced CKD within 12 mo. Older age (hazard ratio [HR] per 5-yr increase 1.15, 95% confidence interval [CI] 1.10–1.20), preoperative hydronephrosis (HR 1.50, 95% CI 1.29–1.76), adjuvant chemotherapy (HR 1.19, 95% CI 1.00–1.41), higher comorbidity index (HR 1.13, 95% CI 1.11–1.16 per point), and lower baseline kidney function (HR 0.75, 95% CI 0.73–0.78) were associated with the development of advanced CKD. Baseline kidney function at the time of surgery was associated with survival. Generalizability is limited due to the predominantly male cohort. ConclusionsImpaired kidney function at baseline is associated with progression to advanced CKD and mortality after radical cystectomy. Preoperative kidney function should be incorporated into risk stratification algorithms for patients undergoing radical cystectomy. Patient summaryImpaired kidney function at baseline is associated with progression to advanced chronic kidney disease and mortality after radical cystectomy.