1135 DETERMINANTS OF LONG-TERM RENAL FUNCTION FOR PATIENTS UNDERGOING RADICAL CYSTECTOMY WITH URINARY DIVERSION

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20111135 DETERMINANTS OF LONG-TERM RENAL FUNCTION FOR PATIENTS UNDERGOING RADICAL CYSTECTOMY WITH URINARY DIVERSION Simon Kim, Igor Frank, Christopher Weight, Mark Shimko, Prabin Thapa, Matthew Tollefson, Sara Farmer, and Stephen Boorjian Simon KimSimon Kim Rochester, MN More articles by this author , Igor FrankIgor Frank Rochester, MN More articles by this author , Christopher WeightChristopher Weight Rochester, MN More articles by this author , Mark ShimkoMark Shimko Rochester, MN More articles by this author , Prabin ThapaPrabin Thapa Rochester, MN More articles by this author , Matthew TollefsonMatthew Tollefson Rochester, MN More articles by this author , Sara FarmerSara Farmer Rochester, MN More articles by this author , and Stephen BoorjianStephen Boorjian Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.734AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing radical cystectomy (RC) for urothelial bladder carcinoma (UBC) remain at life-long risk of chronic kidney disease (CKD). However, the natural history in declines of renal function following RC and the specific risk factors associated with worsening CKD are poorly described. In this study, we investigated long-term renal function after urinary diversion, and evaluated predictors associated with worsening CKD in these patients. METHODS We retrospectively reviewed 1,557 patients who underwent RC for UBC (pTanyNanyM0) from 1980–2000 at the Mayo Clinic. Estimated glomerular filtration rate (GFR), calculated according to MDRD, was used to stratify CKD stage. Generalized linear models were used to estimate associations of pre-operative GFR, hypertension, diabetes, type of diversion (continent vs. incontinent), loss of a renal unit, and postoperative complications with a worsening in CKD stage from pre-RC to last follow-up. RESULTS Median follow-up after RC was 5.8 years (range 0.1–30.3 years). While 38.1% of patients had CKD stages III–V preoperatively, there was a significant increase in stages III–V to 57.1% at last follow-up after RC. On multivariable analysis, risk factors significantly associated with a worsening in CKD stage included lower preoperative GFR, loss of a renal unit, hypertension, and the post-operative complications of hydronephrosis, ureteroenteric stricture, and pyelonephritis (Table). However, the type of urinary diversion was not associated with a worsening of CKD stage in univariate or multivariable analysis. CONCLUSIONS Approximately 20% of patients progressed to moderate-severe CKD on long-term follow-up after RC. Preoperative kidney function, hypertension, loss of a renal unit, and postoperative obstructive and infectious complications are significant risk factors associated with a worsening of CKD stage. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e456 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Kim Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author Christopher Weight Rochester, MN More articles by this author Mark Shimko Rochester, MN More articles by this author Prabin Thapa Rochester, MN More articles by this author Matthew Tollefson Rochester, MN More articles by this author Sara Farmer Rochester, MN More articles by this author Stephen Boorjian Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...