Long-Term Renal Function Following Radical Cystectomy for Bladder Cancer

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer.
• Long-term outcomes, particularly renal function, after RC require thorough evaluation.
• Postoperative renal function decline can significantly impact patient quality of life and survival.

Purpose of the Study:

• To assess long-term renal function changes after radical cystectomy for bladder cancer.
• To identify preoperative and postoperative risk factors associated with renal function decline.
• To understand the impact of renal function loss on patient mortality.

Main Methods:

• Retrospective analysis of 670 patients undergoing RC between 2009-2019.
• Evaluation of renal function using estimated glomerular filtration rate (eGFR) from pre- and postoperative creatinine.
• Application of cumulative incidence and Cox Proportional Hazards models for survival and risk factor analysis.

Main Results:

• Renal insufficiency (eGFR<45 mL/min) increased from 8.9% pre-RC to 19% at 5 years post-RC.
• The 5-year risk of decline to CKD stage G3b or worse was 17%.
• Independent risk factors for decline included lower preoperative eGFR, diabetes, prior pelvic radiation, continent diversion, and ureteral stricture.

Conclusions:

• Long-term renal function significantly decreases in a substantial proportion of patients following RC.
• Preoperative identification of at-risk patients can guide enhanced renal surveillance and early intervention.
• Proactive management of modifiable risk factors is essential to mitigate postoperative renal insufficiency.