The effect of urinary diversion on long-term kidney function after cystectomy.
Age Factors
Aged
Creatinine
/ blood
Cystectomy
/ adverse effects
Female
Follow-Up Studies
Glomerular Filtration Rate
/ physiology
Humans
Kidney
/ physiopathology
Longitudinal Studies
Male
Middle Aged
Postoperative Complications
/ blood
Renal Insufficiency, Chronic
/ blood
Retrospective Studies
Risk Factors
Urinary Bladder Neoplasms
/ surgery
Urinary Diversion
/ adverse effects
Bladder cancer
Cystectomy
Urinary diversion
Journal
Urologic oncology
ISSN: 1873-2496
Titre abrégé: Urol Oncol
Pays: United States
ID NLM: 9805460
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
03
01
2020
revised:
26
03
2020
accepted:
04
05
2020
pubmed:
3
6
2020
medline:
29
6
2021
entrez:
3
6
2020
Statut:
ppublish
Résumé
Cystectomy with urinary diversion is associated with decreased long-term kidney function due to several factors. One factor that has been debated is the type of urinary diversion used: ileal conduit (IC) vs. neobladder (NB). We tested the hypothesis that long-term kidney function will not vary by type of urinary diversion. We retrospectively identified all patients who underwent cystectomy with urinary diversion at our institution from January 1, 2007, to January 1, 2018. Data were collected on patient demographics, comorbid conditions, perioperative radiotherapy, and complications. Creatinine values were measured at several time points up to 120 months after surgery. Glomerular filtration rate (GFR) (ml/min per 1.73 m Among 563 patients who underwent cystectomy with urinary diversion, a NB was used for 72 (12.8%) individuals. Patients who had a NB were significantly younger, had a lower American Society of Anesthesiologists score, greater baseline GFR, better Eastern Cooperative Oncology Group performance status, lower median Charlson comorbidity index, and were less likely to have received preoperative abdominal radiation (all P < 0.05). Both NB and IC patients had decreased kidney function over time, with mean GFR losses at 5 years of 17% and 14% of baseline values, respectively. The IPTW-adjusted linear mixed model revealed that IC patients had slightly more deterioration in kidney function over time, but this was not statistically significant (estimate, 0.12; P = 0.06). The sensitivity analyses yielded a similar trend, in that GFR decrease appeared to be greater in the IC cohort. This trend was statistically significant when using Modification of Diet in Renal Disease (P = 0.04). Among highly selected patients with an NB, deterioration of kidney function may potentially be lower over time than among IC patients. However, the statistical significance varied between analyses and we cautiously attribute these observed differences to patient selection.
Identifiants
pubmed: 32482512
pii: S1078-1439(20)30199-X
doi: 10.1016/j.urolonc.2020.05.003
pii:
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
796.e15-796.e21Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.