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Sources of Funding: University of Florida, Clinical and Translational Research Institute. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Introduction

We determined the effect of radical cystectomy (RC) and urinary diversion (UD) for bladder cancer treatment compared to controls on renal function over time.

Methods

In this retrospective study of 384 patients with bladder cancer who sought care in a tertiary health care center from 2000 to 2014, we determined the effect of RC&UD (n=172) on renal function over time using bladder cancer patients treated without RC&UD (n=212) as a comparison group. Renal function decline was defined using (a) annualized estimated glomerular filtration rate (eGFR) decline and (b) time to decrease in eGFR of 30% or more from baseline. We used propensity score regression adjustment to address confounding by indication. Unadjusted and adjusted linear mixed-effects and Cox proportional hazards models were used to assess the association between RC&UD and eGFR slope and time to decrease in eGFR of 30% or more, respectively.

Results

Mean age was 68±12 years; average follow-up was 17±13 months. Patients with RC&UD experienced a faster decline in renal function over time as compared to those without RC&UD (see Figure). After adjusting for age, propensity score, and other confounding variables, the difference in mean eGFR slope in patients with RC&UD, compared to those without RC&UD, was stable and remained statistically significant (p< 0.001). Patients with RC&UD had a higher risk of eGFR decline of 30% or more, compared to those without RC&UD (unadjusted HR=1.88, 95%CI: 1.35-2.63; p<0.001); this persisted despite adjustment for age but was attenuated and no longer statistically significant after adjustment for propensity score, and confounding variables (adjusted HR=1.01, 95% CI: 0.62-1.63; p=0.976).

Conclusions

RC&UD was independently associated with a faster decline in renal function over time, as measured by annualized eGFR decline. RC&UD was associated with higher risk of eGFR decline of 30% or more in unadjusted analysis but not in adjusted analysis. Our findings will inform future prospective studies to examine this association and investigate intervention strategies to prevent renal injury in this population.

Funding

University of Florida, Clinical and Translational Research Institute. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.