Chronic kidney disease and radical cystectomy for bladder cancer: perioperative and oncologic outcomes in 1,214 patients

Charles Nguyen, Saum Ghodoussipour, Matthew Winter, Giovanni Cacciamani, Hamed Ahmadi, Hooman Djaladat, Anne K. Schuckman, Siamak Daneshmand, Monish Aron, Inderbir Gill, Mihir Desai

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction and Objective: To assess the impact of chronic kidney disease (CKD) on outcomes after radical cystectomy (RC) in patients with bladder cancer treated within a high-volume tertiary referral center. Methods: We identified 1,214 patients who underwent RC with intent to cure from 2009 to 2019. The Modification of Diet in Renal Disease (MDRD) GFR (ml/min/1.73 m²) was calculated and patients were categorized by baseline GFR: Group A = GFR > 60, Group B = GFR > 30–59 and Group C = GFR < 30. Pre-, intra- and postoperative characteristics, oncological outcomes, and 90-day perioperative outcomes were compared. Multivariable logistic regression was used to control for confounding variables. Results: We identified 722 (59.5%) patients in Group A, 448 (36.9%) in Group B, and 44 (3.6%) in Group C. Patients with worse CKD were older and had significantly worse overall comorbidity (all P < 0.001). Neoadjuvant chemotherapy was used in 352 patients (29%), including 182 (25.2%) in Group A, 153 in Group B (35.3%), and 12 in Group C (27.3%). On univariate analysis, worse CKD was associated with higher pathologic stage, lymph node metastases and positive soft tissue margins (all P < 0.0001). The rates of blood transfusion, 90-day complications and readmissions were higher in patients with worse CKD (P < 0.0001, P = 0.02, P = 0.04, respectively). Patients with worse CKD had worse overall survival (77% vs. 73% vs. 55%, P < 0.0001). On multivariable analysis, worse CKD was independently associated with adverse pathology (≥pT3 or node positive) (OR = 6.96, 95%CI 3.20–15.12), 90-day readmissions (OR 2.09, 95%CI 1.11–3.94) and perioperative transfusion (OR 2.08, 95%CI 1.05–4.11). Receipt of neoadjuvant chemotherapy was significantly associated with a decreased risk of adverse pathology (OR 0.51, 95%CI 0.36–0.74) and increased risk of transfusion (OR 2.24, 95%CI 1.70–2.96), but not with mortality, complications, readmissions or length or stay. Conclusion: CKD is prevalent in patients undergoing radical cystectomy. We found CKD to be independently associated with a higher likelihood of adverse pathology, 90-day readmissions, and transfusion.

Original languageEnglish (US)
Pages (from-to)381.e9-381.e16
JournalUrologic Oncology: Seminars and Original Investigations
Volume40
Issue number8
DOIs
StatePublished - Aug 2022
Externally publishedYes

Bibliographical note

Funding Information:
Source of Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Publisher Copyright:
© 2022

Keywords

  • Bladder cancer
  • Chronic kidney disease
  • Outcomes
  • Radical cystectomy

PubMed: MeSH publication types

  • Journal Article

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