Background. Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, renal function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term renal function decline and mortality. Methods. Retrospective study in patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We include patients who had assessment for at least two years post procedure and confirmed live status. We assessed the estimated glomerular filtration rate (eGFR) preoperatively, at first and second year, renal function decline > 10 ml/min/1.73 m2, start dialysis and mortality. Logistic regression analyses were applied to assess risk factors associated, a significant p-value < 0.05 was considered. Results. We included 264 patients, with median age 68.3 years, 73,7% males, main diagnose was bladder cancer 93.3%, TNM stages were grouped in T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73 m2 and after 2 years 58.2 ml/min/1.73 m2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73 m2. Risk factors associated with ESKD included age (HR:1.13, CI95% 1.05–1.22), preoperative eGFR (HR:1.04, CI95% 1.01–1.07). Overall mortality was 43.2%, 75.9% at 5 and 10 years respectively, risk factors were age (HR:1.1, CI95% 1.04–1.18), preoperative eGFR (HR:1.03, CI95% 1.01–1.06) and male gender (HR:14.8, CI95% 1.1–192). Conclusions. Patients with RC have risk of progressive renal function deterioration and high mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of renal function will permit early diagnosis and treatment.
Background: Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, kidney function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term kidney function decline 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 data of at least two years post procedure. We assessed the following outcomes: estimated glomerular filtration rate (eGFR) preoperatively, at first and second year post-procedure, kidney function decline >10 ml/min/1.73m 2 , dialysis commencement and mortality. Logistic regression analyses were applied to assess risk factors associated, a p-value <0.05 was considered significant. Results: We included 264 patients, with median age 68.3 years, 73,7% males. The most common diagnosis was bladder cancer 93.3%, TNM stages were grouped in T≥2 75.9%, N≥1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73m 2 and after 2 years 58.2 ml/min/1.73m 2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease >10 ml/min/1.73m 2 . Risk factors associated with ESKD included; age (HR:1.13, CI95% 1.05-1.22), and pre-operative eGFR (HR:1.04, CI95% 1.01-1.07). Overall mortality was 43.2% and 75.9% at 5 and 10 years respectively, risk factors for which were age (HR:1.1, CI95% 1.04-1.18), preoperative eGFR (HR:1.03, CI95% 1.01-1.06) and male gender (HR:14.8, CI95% 1.1-192). Conclusions: Patients with RC are at risk of progressive kidney function deterioration and elevated mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of kidney function will permit early diagnosis and treatment.
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