Introduction:
Chronic kidney disease (CKD) has been associated with increased risk of cardiovascular events, hospitalization, and mortality. Moreover, patients with CKD are more likely to experience adverse outcomes when diagnosed with bladder cancer. The aim of our study was to investigate the factors associated with the development of clinically significant CKD following radical cystectomy using data from the Veterans Heath Administration (VHA). The VHA is the largest nationally distributed integrated health care system in the US, and bladder cancer represents one of the most common cancers treated across the system. Furthermore, we set out to evaluate patient-, cancer, and treatment-related factors associated with the time to development of clinically significant CKD following radical cystectomy (RC).
Methods:
Using the VHA national utilization files, we identified 3,360 veterans that underwent radical cystectomy for muscle-invasive bladder cancer between 2004 and 2018. We obtained serum creatinine values 6 months prior to surgery and estimated post-operative kidney function starting 30 days after surgery. Our primary outcome was the time to develop clinically significant CKD (stage IV; eGFR of <30 mL/min/1.73 m2) after RC. Multivariable Cox proportional hazards regression models were used to determine risk factors for the development of clinically significant CKD. We also fit multivariable logistic regression hazards models to determine the odds of a patient developing an eGFR <60 mL/min/1.73 m2 in the 12-month period following RC as this is associated with eligibility for cisplatin-based adjuvant chemotherapy. Survival analysis was performed using Kaplan-Meier analysis and Cox proportional hazards regression models to determine clinical variables that contribute independently to mortality following RC.
Results:
Mean age at surgery was 67 years and median preoperative eGFR was 69.
829 (25%) patients progressed to clinically significant CKD within 12 months. Increasing age at surgery (HR 1.11, 95% CI 1.06 to 1.15), pre-operative hydronephrosis (HR 1.55, 95% CI 1.32 to 1.82), receipt of adjuvant chemotherapy (HR 1.20, 95% CI 1.01 to 1.43), and increasing comorbidity index (HR 1.13, 95% CI 1.10 to 1.16) were associated with developing clinically significant CKD following RC. Patients who received neoadjuvant carboplatin and/or adjuvant combination of cisplatin/carboplatin were more likely to develop CKD (HR 1.31, 95% 0.57 to 1.65 and HR 2.74 95% CI 1.71 to 4.39), respectively. Fully adjusted models identified direct relationship between baseline kidney function and development of clinically significant CKD (HR 0.76, 95% CI 0.74 to 0.79) and baseline kidney function was independently associated with overall survival (HR 0.95, 95% CI 0.93 to 0.98, p=0.0006).
Conclusion:
Baseline kidney function is an important risk factor for progressing to clinically significant CKD following RC and an independent predictor of overall survival for bladder cancer after RC. Receipt of chemotherapy and the presence of hydronephrosis, but not the type of urinary diversion, are also associated with renal function decline following cystectomy. Our findings suggest that preoperative CKD stage should be incorporated into risk stratification algorithms for patients undergoing radical cystectomy.
Funding: N/A
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RENAL MORBIDITY FOLLOWING RADICAL CYSTECTOMY IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER
Category
Bladder Cancer > Muscle Invasive Bladder Cancer
Description
Poster #11
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Presented By: Bogdana Schmidt MD, MPH
Authors:
Bogdana Schmidt MD, MPH
Kyla Velaer, MD
I-Chun Thomas, MS
Calyani Ganesan, MD MS
Shen Song, MD
Alan C. Pao, MD
Glenn M. Chertow MD MPH
James D. Brooks, MD
Eila Skinner, MD
John T. Leppert, MD MS