Login to Access Video or Poster Abstract: MP04-16
Sources of Funding: none

Introduction

End stage renal disease patients on hemodialysis (HD) have in increased risk of developing bladder cancer, which is more likely to present in an advanced stage. These patients also have significant risk of non-cancer related morbidity and mortality, especially from cardiovascular disease. Radical cystectomy (RC) is the standard of care for non-metastatic muscle invasive bladder cancer, but is associated with significant morbidity. Despite this high risk scenario, very little is known regarding outcomes in HD patients following RC._x000D_

Methods

The US Renal Disease System database was used for this study, which is a prospective database which includes every HD patient in the United States. A retrospective review of all HD dependent patients who underwent radical RC for bladder cancer between 1989-2013 was performed. Competing risks analysis was used to estimate overall and disease specific survival. Cox regression was used to identify predictors of death.

Results

During the 25-year study period, a total of 1594 patients were identified for analysis, of whom 76.1% were male. The mean age was 70.4 ± 9.8 years. Mean length of stay was 16.2 ± 14.8. Concurrent nephrectomy was undertaken in 33.1% of patients. The 30-day mortality rate was 5.9%. Overall 1, 3, and 5-year survival was 58.4%, 31.4%, and 19.6% respectively. Bladder cancer specific survival at 1, 3, and 5 years was 89.3%, 82.3%, and 80.0% respectively. Predictors of overall mortality were age (HR, 1.03; 95%CI, 1.02-1.03), history of congestive heart failure (CHF) (HR, 1.19; 95%CI, 1.03-1.38), history of diabetes (HR, 1.22; 95%CI, 1.04-1.42), concurrent nephrectomy (HR, 1.09; 95%CI, 1.03-1.14), and female sex (HR, 1.15; 95%CI, 1.01-1.33). Amount of time on HD prior to RC was not predictive of mortality. _x000D_

Conclusions

This represents the largest study to date evaluating outcomes following RC in HD patients. RC is associated with significant morbidity and less than 20% of patients survive 5 years. Older patients, female patients, and those with a history of CHF or diabetes are at an increased risk of mortality._x000D_

Funding

none