Renal function of bladder cancer patients after urinary diversion by ileal conduit in Rajavithi Hospital
Objectives: Our objectives were to evaluate the long-term renal function after radical cystectomy (RC) and ileal conduit diversion (ICD) and to analyze year-by-year the estimated glomerular filtration rate (eGFR) and morphologic upper urinary tract changes.
Materials and Methods: We retrospectively identified 214 patients who had undergone RC and ICD from 2012 to 2018, with regular postoperative follow-up visits. The eGFR was calculated using the Modification of Diet in Renal Disease equation at baseline and during follow-up. A renal function decrease was defined as a greater than 10 mL/min/1.73 m2 reduction in the estimated glomerular filtration rate.
Results: The median follow-up period after RC was 24 months (range, 6-60 months). The median eGFR decreased from 64 mL/min/1.73 m2 (range, 9-125 mL/min/1.73 m2) to 61.5 mL/min/1.73 m2 (range, 8-125 mL/min/1.73 m2). A decline in renal function occurred during the first postoperative years (2.74 mL/ min/1.73 m2 and 3.95 mL/min/1.73 m2 in the first and second year, respectively), with a slight decrease in the subsequent years. The strongest predictor of an eGFR decline was CKD stage 1 or 2 (> 60 mL/min/1.73 m2). Urinary obstruction was diagnosed in 6 patients (2.8%). Among the patients who underwent prompt interventional treatment, we did not find any association with the eGFR decline.
Conclusion: Patients with urinary ICD have a lifelong risk of chronic kidney disease. Regular monitoring of renal function and the morphologic upper urinary tract will permit early diagnosis and treatment of modifiable factors, avoiding irreversible kidney damage.
Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009;55:164-74.
Ku JH, Lerner SP. Variables affecting long-term maintenance of renal function following ileal based urinary diversion. Eur Urol 2012;61:498-502.
Eisenberg MS, Thompson RH, Frank I, Kim SP, Cotter KJ, Tollefson MK, et al. Long-term renal function outcomes after radical cystectomy. J Urol 2014;191:619-25.
Jin XD, Roethlisberger S, Burkhard FC, Birkhaeuser F, Thoeny HC, Studer UC. Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution. Eur Urol 2012;1:491-7.
Levey AS, Stevens LA, Schmid CH, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular Filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70.
Osawa T, Shinhara N, Maruyama S, Oba K, Abe T, Maru S. Long-term renal function outcomes in bladder cancer after radical cystectomy. Urol J 2013; 10:784-9.
Rouanne M, Perreaud A, Letang N, Yonneau L, Neuzillet Y, Hervé JM, Botto H, et al. Trends in renal function after radical cystectomy and ileal conduit diversion: new insights regarding estimated glomerular filtration rate variations. Clin Genitourin Cancer 2015;13:e139-44.
Guzzo TJ, Vaughn DJ. Management of Metastatic and Invasive Bladder Cancer. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier; 2016. p. 2223.
Copyright (c) 2021 Insight Urology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.