Long-term renal function following radical cystectomy and ileal conduit creation,Irish Journal of Medical Science

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Long-term renal function following radical cystectomy and ileal conduit creation
Irish Journal of Medical Science ( IF 1.7 ) Pub Date : 2023-09-24 , DOI: 10.1007/s11845-023-03524-1
Julio Chevarria ₁ , Chaudhry A Ebad ₁ , Mairead Hamill ₁ , Catalin Constandache ₂ , Cliona Cowhig ₁ , Dilly M Little ₂ , Peter J Conlon ₁

Affiliation

Background

Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion; RC is associated with long-term morbidity, kidney impairment and mortality.

Aim

To identify risk factors associated with postoperative long-term kidney function and mortality.

Methods

Retrospective study of patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We included patients who had follow-up at least 2 years post-procedure. We assessed estimated glomerular filtration rate (eGFR) preoperatively and yearly post-procedure, dialysis commencement and mortality. Cox and Fine-Gray regression analyses were applied; p-value < 0.05 was considered significant.

Results

We included 264 patients, median age 68.3 years, 73.7% males. The most common diagnosis was bladder cancer 93.3%, TNM stages T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73m² and after 2 years 58.2 ml/min/1.73m² (p: 0.009); 5.3% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73m². Risk factors associated with ESKD and start dialysis included younger age (HR: 0.90, CI 95% 0.87–0.94) and lower pre-operative eGFR (HR: 0.97, CI 95% 0.94–1.00). Overall mortality was 43.2% and 54.1% at 5 and 10 years, respectively; risk factors were older age (HR: 1.04, CI 95% 1.02–1.06), tumour stage T ≥ 2 (HR: 2.22, CI 95% 1.39–3.54) and no chemotherapy (HR: 1.72, CI 95% 1.18–2.51). Limitations include retrospective design, absence of control group and single centre experience.

Conclusions

Patients with RC are at risk of progressive kidney function deterioration and elevated mortality and the main risk factors associated were age and preoperative eGFR. Regular monitoring of kidney function will permit early diagnosis and treatment.

中文翻译：

根治性膀胱切除术和回肠导管创建后的长期肾功能

背景

膀胱癌的治疗包括根治性膀胱切除术（RC）和尿流改道； RC 与长期发病率、肾功能损害和死亡率相关。

目的

确定与术后长期肾功能和死亡率相关的危险因素。

方法

对 1996 年至 2016 年博蒙特医院接受 RC 和尿流改道的患者进行回顾性研究。我们纳入了术后至少 2 年随访的患者。我们评估了术前和术后每年的估计肾小球滤过率（eGFR）、透析开始和死亡率。应用 Cox 和 Fine-Gray 回归分析； p值<0.05被认为是显着的。

结果

我们纳入了 264 名患者，中位年龄 68.3 岁，73.7% 为男性。最常见的诊断为膀胱癌，占 93.3%，TNM 分期T ≥ 2 占 75.9%， N ≥ 1 占 47.6%， M 1 占 28%。术前 eGFR 中位数为 65.8 ml/min/1.73m ² ，2 年后为 58.2 ml/min/1.73m ² ( p : 0.009)； 5.3% 需要长期透析，32.8% 下降> 10 ml/min/1.73m ² 。与 ESKD 和开始透析相关的危险因素包括年龄较小（HR：0.90，CI 95% 0.87–0.94）和较低的术前 eGFR（HR：0.97，CI 95% 0.94–1.00）。 5 年和 10 年总死亡率分别为 43.2% 和 54.1%；危险因素包括年龄较大（HR：1.04，CI 95% 1.02–1.06）、肿瘤分期T ≥ 2（HR：2.22，CI 95% 1.39–3.54）和未接受化疗（HR：1.72，CI 95% 1.18–2.51）。局限性包括回顾性设计、缺乏对照组和单中心经验。