医学
膀胱切除术
泌尿科
肾功能
膀胱癌
肾脏疾病
围手术期
比例危险模型
肾积水
内科学
外科
泌尿系统
癌症
作者
Hamed Ahmadi,Sharath Reddy,Charles Nguyen,Antoin Douglawi,Sanam Ladi‐Seyedian,Sidney Roberts,Alireza Ghoreifi,Saum Ghodoussipour,Sumeet Bhanvadia,Hooman Djaladat,Anne Schuckman,Siamak Daneshmand
出处
期刊:BJUI
[Wiley]
日期:2022-01-27
卷期号:130 (2): 200-207
被引量:6
摘要
Objective To evaluate long‐term renal function in patients with chronic kidney disease (CKD) Stage IIIa who underwent radical cystectomy and orthotopic neobladder (RC/ONB) compared to matched controls. Patients and Methods Using our Institutional Review Board‐approved institutional database, patients with a glomerular filtration rate (GFR) of 45–59.9 mL/min/1.73 m 2 who underwent RC/ONB were identified. A control group of patients with a GFR of ≥60 mL/min/1.73 m 2 was selected. Groups were matched based on age, baseline hypertension/diabetes mellitus, perioperative chemotherapy, and preoperative hydronephrosis. A decrease in GFR of >10 mL/min/1.73 m 2 during the follow‐up was considered significant. A multivariate Cox regression analysis was performed to identify predictors of GFR decline in each group. Results Of 1237 patients who underwent RC/ONB, 508 patients were included (254 per group). The mean preoperative GFR was 53.3 mL/min/1.73 m 2 in the study group and 78.8 mL/min/1.73 m 2 in controls. The median follow‐up was 3.7 years. During follow‐up, GFR stayed at or above baseline in 51% of the study patients compared to 46% of the controls ( P = 0.5). The mean time to a significant GFR decline in the study patients was significantly longer compared to the controls (5.6 vs 2 years, respectively; P < 0.001). In multivariate analysis, neoadjuvant chemotherapy was found to be the strongest predictor of a significant GFR decline as well as GFR decline below baseline (hazard ratio [HR] 2.15, 95% confidence interval [CI] 1.4–3.29, P = 0.004; and HR 2.15, 95% CI 1.4–3.29, P < 0.001, respectively). Conclusion Patients with CKD Stage IIIa who undergo ONB appear to have comparable long‐term renal function to those with a GFR of ≥60 mL/min/1.73 m 2 . An ONB reconstruction is a safe option for patients with CKD Stage IIIa desiring a continent diversion.
科研通智能强力驱动
Strongly Powered by AbleSci AI