Long-Term Renal Function in Patients with CKD following Radical Cystectomy and Orthotopic Neobladder.

To evaluate long-term renal function in patients with CKD IIIa who underwent radical cystectomy and orthotopic neobladder (RC/ONB) compared to matched controls.

Using our IRB-approved institutional database, patients with glomerular filtration rate (GFR) 45-59. 9 ml/min who underwent RC/ONB were identified. A control group of patients with GFR≥60 ml/min was selected. Groups were matched based on age, baseline hypertension/diabetes mellitus, perioperative chemotherapy, and preoperative hydronephrosis. A decrease in GFR >10 ml/min during the follow-up was considered significant. A multivariate Cox regression analysis was performed to identify predictors of GFR decline in each group.

Of 1237 patients who underwent RC/ONB, 508 patients were included (254 per group). Mean preoperative GFR was 53.3 ml/min in the study group and 78.8 ml/min in controls. Median follow-up was 3.7 years. During follow-up, GFR stayed at or above baseline in 51% of study patients compared to 46% of controls (P=0.5). Mean time to significant GFR decline in study subjects was significantly longer compared to controls (5.6 years vs 2 years, respectively; P<0.001). In multivariate analysis, neoadjuvant chemotherapy was found to be the strongest predictor of significant GFR decline as well as GFR decline below baseline (HR=2.15, 95% CI 1.4 - 3.29; P=0.004 and HR=2.15, 95% CI 1.4 - 3.29; P<0.001, respectively).

Patients with CKD IIIa who undergo ONB appear to have comparable long-term renal function to those with GFR ≥60 ml/min. ONB reconstruction is a safe option for patients with CKD IIIa desiring continent diversion.

BJU international. 2022 Jan 19 [Epub ahead of print]

Hamed Ahmadi, Sharath Reddy, Charles Nguyen, Antoin Douglawi, Sanam Ladi-Seyedian, Sidney Roberts, Alireza Ghoreifi, Saum Ghodoussipour, Sumeet K Bhanvadia, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand

Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA., Division of Urology, Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA.

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