According to a study, chronic kidney disease is associated with a higher likelihood of adverse pathology, 90-day readmissions, and transfusion, among patients who have undergone a radical cystectomy for bladder cancer. As Charles Nguyen, MD, Keck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA and colleagues wrote, “patients with preoperative chronic kidney disease have been shown to have worse 5-year progression-free survival, cancer specific survival, and overall survival after [radical cystectomy]” but “further insight into the effect of perioperative [chronic kidney disease] is needed.”

Using a prospectively collated database, 1214 patients who underwent radical cystectomy with the intent to cure between August 2009 and December 2019 were included in the study. Using the Modification of Diet in Renal Disease glomerular filtration rate (GFR, ml/min/1.73m²), patients were categorized into the following cohorts: those with GFR > 60 (Group A; n = 722), those with GFR >30 and ≤59 (Group B; n = 448), and those with GFR <30 (Group C; n = 44). Data on pre-, intra-, and postoperative characteristics, oncological outcomes, and 90-day perioperative outcomes were gathered for all patients.

According to univariable analysis, worse chronic kidney disease was associated with higher pathologic stage, lymph node metastases, and positive soft tissue margins (P <.0001). Among patients with worse chronic kidney disease, there were also higher rates of blood transfusion (P <.0001) and 90-day complications (P = .02) and readmissions (P = .04). Patients with worse chronic kidney disease also had worse overall survival (77% in Group A, 73% in Group B, and 55% in Group C; P <.0001).

Upon multivariable analysis, there was an independent association between worse chronic kidney disease and adverse pathology (extravesical and nodal positive disease; odds ratio [OR], 6.96; 95% confidence interval [CI], 3.20 to 15.12), 90-day readmission (OR, 2.09; 95% CI, 1.11 to 3.94), and perioperative transfusion (OR, 2.08; 95% CI, 1.05 to 4.11).

While there was a significant association between treatment with neoadjuvant chemotherapy and decreased risk of adverse pathology (OR, 0.51; 95% CI, 0.36 to 0.74) and increased risk of transfusion (OR, 2.24; 95% CI, 1.70 to 2.96), this association was not seen with mortality, complications, readmissions, or length of stay.

Dr Nguyen and colleagues concluded, “Further studies investigating the cause-effect relationship between [chronic kidney disease] status and worse oncologic outcomes should be explored.”

Source:

Nguyen C, Ghodoussipour S, Winter M, et al. Chronic kidney disease and radical cystectomy for bladder cancer: Perioperative and oncologic outcomes in 1214 patients. Urol Oncol. 2022. 40(8):381.e9-381.e16. doi:10.1016/j.urolonc.2022.04.010