Comparative impact of continent and incontinent urinary diversion on long‐term renal function after radical cystectomy in patients with preoperative chronic kidney disease 2 and chronic kidney disease 3a

Abstract

Objectives: To evaluate the differences in estimated glomerular filtration rate decline by urinary diversion type (incontinent diversion vs continent diversion) and preoperative estimated glomerular filtration rate among patients undergoing radical cystectomy and urinary diversion. Methods: We evaluated 1383 patients treated with radical cystectomy between 1980-2006 who had a preoperative estimated glomerular filtration rate of 45-89 mL/ min/1.73 m 2 . Estimated glomerular filtration rate was estimated using Chronic Kidney Disease Epidemiology Collaboration equations, and patients were stratified by preoperative estimated glomerular filtration rate into chronic kidney disease 2 (estimated glomerular filtration rate 60-89 mL/min/1.73 m 2 ) and chronic kidney disease 3a (estimated glomerular filtration rate 45-59 mL/min/1.73 m 2 ). Multiple definitions of estimated glomerular filtration rate decline were evaluated: (i) 10-point decline in estimated glomerular filtration rate; (ii) 20% decline in estimated glomerular filtration rate; and (iii) 10% decline in estimated glomerular filtration rate. Time to estimated glomerular filtration rate decline was compared using the Kaplan-Meier method stratified by diversion type. Cox regression models were used to evaluate the association of diversion type with estimated glomerular filtration rate decline risk. Results: In total, 74% (1021/1383) of patients underwent incontinent diversion and 26% (362/1383) underwent continent diversion. Preoperative chronic kidney disease 2 and chronic kidney disease 3a were noted among 59% and 41% of patients who underwent incontinent diversion, versus 74% and 26% with continent diversion. Median follow up after RC was 11.2 years. The rate of estimated glomerular filtration rate decline in patients with incontinent diversion versus continent diversion was similar when stratified by preoperative chronic kidney disease 2 and preoperative chronic kidney disease 3a, regardless of estimated glomerular filtration rate decline definition. On multivariable analysis, continent diversion was not associated with estimated glomerular filtration rate decline for patients with preoperative chronic kidney disease 3a.Conclusions: The risk of estimated glomerular filtration rate decline over 10 years was not significantly different after incontinent diversion versus continent diversion among patients with preoperative chronic kidney disease 2 or chronic kidney disease 3a. Continent diversion does not appear to confer an independently increased risk of estimated glomerular filtration rate decline in patients with preoperative chronic kidney disease 3a.

Long-term renal function and mortality after radical cystectomy and ileal conduit formation.

“…The demographics of our cohort are similar to that of previous studies in terms of age, gender (10)(11)(12)(13)(14)(18)(19)(20), mean follow up period 7.5 to 10 years (5, 11-14, 19, 20), prevalence of hypertension and diabetes (10-12, 14, 19, 20), indication for RC bladder cancer (10-12, 14, 18, 19), with stages T ≥ 2 from 63 to 78% (12,19,20), therefore, our study is comparable to these previous reports.…”

Editorial Comment from Dr Abe to Comparative impact of continent and incontinent urinary diversion on long‐term renal function after radical cystectomy in patients with preoperative chronic kidney disease 2 and chronic kidney disease 3a

“…In the present study, the authors carried out subanalyses, dividing their cohort by baseline estimated glomerular filtration rate levels and using several end‐points of renal function decline. They further confirmed in a large cohort that the risk of renal deterioration was not significantly different between patients undergoing continent and incontinent diversion, regardless of the preoperative chronic kidney disease stage (chronic kidney disease 2 or chronic kidney disease 3a) . Because other studies including those of our group were restricted by the short follow up or by analyzing renal deterioration with the use of a single end‐point (for example, 25% decrease of baseline estimated glomerular filtration rate), the present study provided more practicable information for both clinicians and patients in terms of determination of the type of urinary diversion before surgery, or a reference standard for postoperative renal function after surgery.…”

The Course of Renal Function After Radical Cystectomy with Ileal Conduit Diversion for Bladder Cancer

“…In our study, renal function deterioration was seen in 53.3% of patients in the first year and 41.1% of patients in the fifth year. (1,2,3,24,25,26,27). Although the preoperative and postoperative eGFR values were statistically insignificant, the development of postoperative urinary tract obstruction and postoperative urinary tract infection were the only significant risk factors for renal deterioration.…”

“…Definition of renal deterioration is also unclear. When we look at the small number of studies available in the literature which have used eGFR, we see that there are different definitions such as CKD stage changes, 25% decline in eGFR from baseline and a decrease in eGFR by >1 mL/min/1.73 m 2 per year (1,2,3,24). In this study, we used the eGFR and annual change in eGFR.…”