Introduction: Orthotopic neobladder (ONB) reconstruction following radical cystectomy (RC) is generally discouraged in patients with chronic kidney disease (CKD) as it is believed that it would cause significant electrolyte disturbances and worsening renal function in the long run. This study aims to evaluate long-term renal function outcomes of bladder cancer patients with CKD who received ONB.
Methods: According to our institutional IRB approved cystectomy database from January 2003 to December 2018, 2182 patients underwent RC for bladder cancer. ONB was constructed in 1280 (59%) patients of whom 273 had preoperative glomerular filtration rate (GFR) between 45 to 60 ml per minute/1.73 m2. Sixteen patients were excluded due to lack of follow up. Renal function was recorded at various time points postoperatively. A decrease in GFR > 10 ml per minute/1.73 m2 was considered as significant GFR drop. A multivariate cox regression analysis was performed to identify predictors of significant GFR drop.
Results: A total of 257 patients with complete follow up were included in this study (Table 1). Median follow-up was 2 years (IQR 7 months, 5 years). Mean preoperative GFR was 53.3 ± 4.2 ml per minute/1.73 m2. At 10-year mark follow up, 132 (51.3%) patients did not have any significant GFR drop (Figure 1). GFR also remained above 45 ml per minute/1.73 m2 in 125 (49%) patients. The median time to significant GFR drop was 1 year. On multivariate analysis, risk factors associated with significant GFR drop were age (HR 1.3, 95%CI: 1.3-5; P <0.006), neoadjuvant chemotherapy (HR 1.83, 95%CI: 1.2-2.7; P= 0.002), diabetes (HR 1.6, 95%CI: 1-2.6, P=0.02) and any complication within 30 days post-operatively (HR 1.47, 95%CI: 1-2.1, P=0.04).
Conclusions: A significant proportion of patients with CKD and ONB seems to have a stable long term renal function and their baseline GFR does not seem to affect their long term renal function outcome. Source of
