Reduced Estimated Glomerular Filtration Rate (eGFR <60 ml/min) at First Transurethral Resection of Bladder Tumor is a Significant Predictor of Subsequent Recurrence and Progression

To evaluate if moderate CKD (eGFR <60 ml/min) is associated with high rates of NMIBC recurrence or progression.

A multi-institutional database identified patients with serum creatinine values prior to first TURBT. CKD-epidemiology collaboration formula calculated patient estimated glomerular filtration rate (eGFR). Cox proportional hazards models evaluated associations with recurrence-free (RFS) and progression-free survival (PFS).

A total of 727 patients were identified with a median patient age of 69.8 (IQR 60.1-77.6). Data for eGFR was available for 632 patients. During a median follow-up of 3.7 (IQR 1.5-6.5) years, 400 (55%) patients had recurrence and 145 (19.9%) patients had progression of tumor stage or grade. Moderate or severe CKD was identified in 183 patients according to eGFR. Multivariable analysis identified eGFR < 60 (HR 1.5, 95% CI 1.2-1.9; p=0.002) as a predictor of tumor recurrence. The 5-year RFS rate was 46% for patients with an eGFR ≥ 60 ml/min and 27% for patients with an eGFR <60 ml/min (p=0.0004). Multivariable analysis demonstrated eGFR <60 ml/min (HR 3.7, 95% CI 1.75-7.94; p=0.001) was associated with progression to muscle-invasive disease. The 5-year PFS rate was 83% for patients with an eGFR ≥ 60 ml/min and 71% for patients with an eGFR <60 ml/min (p=0.01).

Moderate CKD at first TUR is associated with reduced RFS and PFS. Patients with reduced renal function should be considered for increased surveillance.

BJU international. 2017 May 02 [Epub ahead of print]

Michael L Blute, Victor Kucherov, Timothy J Rushmer, Shivashankar Damodaran, Fangfang Shi, E Jason Abel, David F Jarrard, Kyle A Richards, Edward M Messing, Tracy M Downs

Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI., Department of Urology, University of Rochester, Rochester, NY., University of Wisconsin School of Medicine and Public Health, Madison, WI.