CKD Associated With Worse Radical Cystectomy Outcomes

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09/13/2021

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renalandurologynews.com

Chronic kidney disease (CKD) is highly prevalent among patients undergoing radical cystectomy (RC) for bladder cancer and is associated with adverse oncologic and perioperative outcomes, according to study findings presented during the AUA2021 Virtual Experience.

“CKD is associated with a higher likelihood of non-organ confined disease and lymph node metastases and post-operative transfusion as well as 90-day readmissions,” first author Charles Nguyen, MD, reported in an oral presentation.

Dr. Nguyen and colleagues at the University of Southern California’s Keck School of Medicine in Los Angeles studied 1214 patients undergoing RC. Of these, 722 had no CKD (estimated glomerular filtration rate [eGFR] greater than 60 mL/min/1.73 m2), 448 (36.9%) had CKD stage 3 (eGFR 30-59 mL/min/1.73 m2) and 44 (3.6%) had CKD stage 4 (eGFR less than 30 mL/min/1.73 m2).

The 90-day readmission rates were 28% for the no-CKD group compared with 32.6% and 43.2% for those with CKD stages 3 and 4, respectively.

Patients with CKD stage 4 were more likely to have adverse pathology compared with the other groups. The proportion of patients with pT3 or greater disease and positive lymph nodes was 68.2% and 45.5%, respectively, among the patients with CKD stage 4 compared with 37.5% and 24.8%, respectively, for those with CKD stage 3 and 28.9% and 18.8%, respectively, for those without CKD. 

On multivariable analysis, an eGFR less than 30 mL/min/1.73 m2 was significantly associated with approximately 7-fold increased odds of extravesical or node-positive disease, 2.1-fold increased odds of 90-day readmission, 2.4-fold increased odds for 90-day complications, and 2.1-fold increased odds for perioperative blood transfusion.

Reference

Nguyen C, Ghodoussipour S, Winter M, et al. Chronic kidney disease and radical cystectomy for bladder cancer: Perioperative and oncologic outcomes in 1,214 patients. Presented at: AUA2021 Virtual Experience held September 10-13, 2021. Abstract MP41-05.

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