scholarly journals Long-term kidney function and mortality after radical cystectomy and ileal conduit formation.

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Chaudhry A. Ebad ◽  
Mairead Hamill ◽  
Catalin Constandache ◽  
Cliona Cowhig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Kidney Function ◽  
Urinary Diversion ◽  
Factors Associated ◽  
Post Procedure ◽  
Common Diagnosis ◽  
Kidney Function Decline

Abstract Background: Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, kidney function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term kidney function decline and mortality. Methods: Retrospective study of patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We included patients who had follow up data of at least two years post procedure. We assessed the following outcomes: estimated glomerular filtration rate (eGFR) preoperatively, at first and second year post-procedure, kidney function decline >10 ml/min/1.73m 2 , dialysis commencement and mortality. Logistic regression analyses were applied to assess risk factors associated, a p-value <0.05 was considered significant. Results: We included 264 patients, with median age 68.3 years, 73,7% males. The most common diagnosis was bladder cancer 93.3%, TNM stages were grouped in T≥2 75.9%, N≥1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73m 2 and after 2 years 58.2 ml/min/1.73m 2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease >10 ml/min/1.73m 2 . Risk factors associated with ESKD included; age (HR:1.13, CI95% 1.05-1.22), and pre-operative eGFR (HR:1.04, CI95% 1.01-1.07). Overall mortality was 43.2% and 75.9% at 5 and 10 years respectively, risk factors for which were age (HR:1.1, CI95% 1.04-1.18), preoperative eGFR (HR:1.03, CI95% 1.01-1.06) and male gender (HR:14.8, CI95% 1.1-192). Conclusions: Patients with RC are at risk of progressive kidney function deterioration and elevated mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of kidney function will permit early diagnosis and treatment.

scholarly journals Long-term renal function and mortality after radical cystectomy and ileal conduit formation.

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Chaudhry A. Ebad ◽  
Mairead Hamill ◽  
Catalin Constandache ◽  
Cliona Cowhig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Renal Function ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Beaumont Hospital ◽  
Renal Function Decline ◽  
Factors Associated ◽  
Renal Function Deterioration

Abstract Background. Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, renal function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term renal function decline and mortality. Methods. Retrospective study in patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We include patients who had assessment for at least two years post procedure and confirmed live status. We assessed the estimated glomerular filtration rate (eGFR) preoperatively, at first and second year, renal function decline > 10 ml/min/1.73 m2, start dialysis and mortality. Logistic regression analyses were applied to assess risk factors associated, a significant p-value < 0.05 was considered. Results. We included 264 patients, with median age 68.3 years, 73,7% males, main diagnose was bladder cancer 93.3%, TNM stages were grouped in T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73 m2 and after 2 years 58.2 ml/min/1.73 m2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73 m2. Risk factors associated with ESKD included age (HR:1.13, CI95% 1.05–1.22), preoperative eGFR (HR:1.04, CI95% 1.01–1.07). Overall mortality was 43.2%, 75.9% at 5 and 10 years respectively, risk factors were age (HR:1.1, CI95% 1.04–1.18), preoperative eGFR (HR:1.03, CI95% 1.01–1.06) and male gender (HR:14.8, CI95% 1.1–192). Conclusions. Patients with RC have risk of progressive renal function deterioration and high mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of renal function will permit early diagnosis and treatment.

scholarly journals P0570THE INCIDENCE, RISK FACTORS OF ACUTE KIDNEY DISEASES AND DISORDERS AND ITS IMPACT ON CHRONIC KIDNEY DISEASE IN PATIENTS AFTER RADICAL CYSTECTOMY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shengnan Ge ◽  
Ying Tang ◽  
Junzhe Chen ◽  
Wenjuan Yu ◽  
Anping Xu
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Bladder Cancer ◽  
Kidney Disease ◽  
Radical Cystectomy ◽  
Kidney Diseases ◽  
Operation Time ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Incidence Risk

Abstract Background and Aims Acute kidney injury (AKI) is a widely-discussed complication associated with the radical cystectomy which is the gold standard for the management of invasive bladder cancer. Until now, few studies investigate the new criteria named Acute Kidney Diseases and Disorders(AKD) as the complication of radical cystectomy. In this study, we evaluated the incidence, risk factors of AKD and evaluate its impact on chronic kidney disease (CKD) in patients after radical cystectomy. Method A total of 279 patients who underwent radical cystectomy at Sun Yat-sen Memorial Hospital, Guangzhou, China, from January 2006 to June 2019 were evaluated, including 168 patients for Robotic-assisted Laparoscopic Radical Cystectomy (RLRC) and 111 patients for Laparoscopic Radical Cystectomy(LRC). AKD was diagnosed according to the classification scheme proposed in the 2012 KDIGO guideline. Logistic regression modeling was used to explore risk factors of AKD, while risk factors associated with CKD in AKD patients were investigated using Kaplan-Meier analysis, respectively. Results The overall incidence of AKD after radical cystectomy was 34.1% (95 out of 279) ,the incidences differ significantly between the RLRC and LRC groups (67 [39.9%] vs 28 [25.2%], P=0.011). Among 279 patients, risk factors associated with postoperative AKD included RLRC (OR 2.067, 95%CI 1.188 to 3.595, P=0.010), Age (years) (OR 1.046, 95%CI 1.018 to 1.074, P=0.001), baseline eGFR&lt;60(ml/(min.1.73m2) (OR 2.662, 95%CI 1.355 to 5.230, P=0.004), Further subgroup analysis identified age, operation time&lt;250(min) as important risk factors of AKD in RLRC patients but not in LRC patients. Of 211 patients with a preoperative estimated glomerular filtration rate (eGFR) of &gt; 60 ml/min/1.73 m2, CKD developed in 16.0% (21/ 131) of patients in the non-AKD group and 36.3% (29/ 80) of patients in the AKD group. Kaplan-Meier analysis(shown in figure 1) identified that AKD is associated with higher CKD rates in those patients (P &lt;0.001). Conclusion One-third of bladder cancer patients developed AKD after after radical cystectomy. RLRC, Age, baseline eGFR &lt;60(ml/(min.1.73m2) were independent risk factors for postoperative AKD in all patients. Occurance of AKD could increase the risk of new-onset CKD in the long run. Though the use of RLRC is now well established, we should be aware that it may increase the risk of postoperative AKD, especially for patients who are old and with lower eGFR .Besides, we should try to improve the management of those AKD patients with aim toward preventing further development of CKD.

scholarly journals Risk of Fracture After Radical Cystectomy and Urinary Diversion for Bladder Cancer

2014 ◽  
Vol 32 (29) ◽  
pp. 3291-3298 ◽  
Author(s):  
Amit Gupta ◽  
Coral L. Atoria ◽  
Behfar Ehdaie ◽  
Shahrokh F. Shariat ◽  
Farhang Rabbani ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Population Based ◽  
Population Based Study ◽  
Risk Of Fracture ◽  
Disease Characteristics ◽  
Increased Risk ◽  
Cystectomy Group

Purpose Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture. Patients and Methods Population-based study using SEER-Medicare–linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics. Results The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage. Conclusion Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture.

Understanding risk factors associated with early unplanned reoperation after radical cystectomy and urinary diversion

2019 ◽  
Vol 18 (1) ◽  
pp. e1313-e1314
Author(s):  
M. Laymon ◽  
F.K. Ghobrial ◽  
A. Hashem ◽  
H. Abol-Enein ◽  
A. Shaaban ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Factors Associated

scholarly journals Comparison of survival in elderly patients treated with uretero-cutaneostomy or ileal conduit after radical cystectomy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shang Huang ◽  
Hanzhong Chen ◽  
Teng Li ◽  
Xiaoyong Pu ◽  
Jiumin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Bladder Cancer ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Tumor Stage ◽  
Node Density ◽  
Cancer Specific Survival

Abstract Background In bladder cancer patients with age ≥ 80 years old, there have been controversies in performing uretero-cutaneostomy or ileal conduit as urinary diversion after radical cystectomy. Limited study evaluated overall survival (OS) and cancer-specific survival (CSS) between the two urinary diversions in elderly patients. This study is to compare OS and CSS between uretero-cutaneostomy and ileal conduit after radical cystectomy in bladder cancer patients with age ≥ 80 years old. Patients and methods Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Bladder cancer patients diagnosed between 2004 and 2016 with age ≥ 80 years old who underwent radical cystectomy with either UC or IC were selected. After propensity score matching, Cox regression and Kaplan-Meier analysis were used to analyze the survival. We calculated statistical power for survival. Results Of 1394 patients who met the inclusion criteria, 1093 underwent ileal conduit and 301 underwent uretero-cutaneostomy. After propensity score matching, 285 patients were included in each group. Multivariable Cox analysis showed urinary diversion was not a risk factor of OS and CSS (HR 1.044, [95% CI 0.867–1.257] and 1.012 [0.748–1.368], respectively). Both OS and CSS were not significantly different, with median survival of ileal conduit and uretero-cutaneostomy were 19 [16–24] months and 19 [15–26] months respectively. Additionally, We found OS had the following risk factors: tumor stage (distant vs regional vs localized, 5.332 [3.610–7.875] vs 1.730 [1.375–2.176] vs 1), node density (>0.2 vs ≤0.2 vs none, 1.410 [1.047–1.898] vs 0.941 [0.658–1.344] vs 1) and age (1.067 [1.032–1.103] for each year). While CSS had the following risk factors: tumor stage (distant vs regional vs localized, 4.035 [2.046–7.959] vs 2.476 [1.651–3.713] vs 1), node density (>0.2 vs ≤0.2 vs none, 2.501 [1.645–3.804] vs 1.062 [0.590–1.914] vs 1) and tumor size (greater than 3 cm vs less than 3 cm, 1.596 [1.057–2.412] vs 1). Our analysis obtained 0.707 power for overall survival. Conclusion Urinary diversion by uretero-cutaneostomy or by ileal conduit was not associated with overall and cancer-specific survival. It is reasonable to consider uretero-cutaneostomy as a regular procedure of urinary diversion in elderly bladder cancer patients after radical cystectomy to avoid associate complications.

scholarly journals OP0133 THE PREVALENCE AND RISK FACTORS OF RETINAL TOXICITY ASSOCIATED WITH LONG-TERM HYDROXYCHLOROQUINE USE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 77-78
Author(s):  
S. Do ◽  
J. H. Du ◽  
J. X. An ◽  
J. Wang ◽  
A. Lin
Keyword(s):  
Risk Factors ◽  
Cumulative Dose ◽  
Daily Intake ◽  
Retinal Toxicity ◽  
Factors Associated ◽  
Duration Of Therapy ◽  
Increased Risk ◽  
Hydroxychloroquine Retinopathy ◽  
Risk Of Retinopathy

Background:Hydroxychloroquine (HCQ) is commonly used for the treatment of various autoimmune diseases. The medication is generally well-tolerated. However, long-term use after 5 years may increase the risk of retinopathy. One study in 2014 has demonstrated the risk can be as high as 7.5%. Optical Coherence Tomography (OCT) has become a major modality in screening retinopathy.Objectives:To evaluate the prevalence of retinal toxicity among patients using hydroxychloroquine and to determine various risk factors associated with hydroxychloroquine-associated retinal toxicity.Methods:We performed a retrospective chart review on a cohort of adult patients with long-term use (≥ 5 years cumulative) of HCQ between January 1st, 2011 to December 31st, 2018 from the Kaiser Permanente San Bernardino County and Riverside medical center areas in Southern California, USA. Patients were excluded if they had previously been diagnosed with retinopathy prior to hydroxychloroquine use, were deceased, or had incomplete OCT exam. Our primary endpoint was the prevalence of patients who developed retinal toxicity detected by OCT, and later confirmed by retinal specialist. Potential risk factors (age, duration of therapy, daily consumption per actual body weight, cumulative dose, confounding diseases and medication) for developing retinopathy were also evaluated. Univariable and multivariable logistic regression analyses were used to determine risk factors associated with retinal toxicity.Results:Among 676 patients exposed to more than 5 years of HCQ, the overall prevalence of retinal toxicity was 6.8%, and ranged from 2.5% to 22.2% depending on the age, weight-based dosing, duration of use and cumulative dose. Duration of therapy for 10 years or more increased risk of retinopathy by approximately 5 to 19 folds. Similarly, weight-based dose of 7 mg/kg/day or greater was assciated with increased risk of retinopathy by approximately 5 times. Patients with cumulative dose of 2000 grams or more had greater than 15 times higher risk of developing retinopathy. Duration of use for10 years or more (odd ratio 4.32, 95% CI 1.99 – 12.49), age (odd ratio 1.04; 95% CI 1.01 - 1.08), cumulative dose of more than 1500 g (odd ratio 7.4; 95% CI 1.40 – 39.04) and atherosclerosis of the aorta (odd ratio 2.59; 95% CI, 1.24 – 5.41) correlated with higher risk of retinal toxicity.Conclusion:The overall prevalence of retinopathy was 6.8%. Regular OCT screening, especially in patients with hydroxychloroquine use for more than 10 years, daily intake > 7 mg/kg, or cumulative dose > 1500 grams is important in detecting hydroxychloroquine-associated retinal toxicityReferences:[1]Hobbs HE. Sorsby A, & Freedman A. Retinopathy Following Chloroquine Therapy. The Lancet. 1959; 2(7101): 478-480.[2]Levy, G. D., Munz, S. J., Paschal, J., Cohen, H. B., Pince, K. J., & Peterson, T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis & Rheumatism: 1997; 40(8): 1482-1486.[3]Ding, H. J., Denniston, A. K., Rao, V. K., & Gordon, C. Hydroxychloroquine-related retinal toxicity. Rheumatology. 2016; 55(6): 957-967.[4]Stelton, C. R., Connors, D. B., Walia, S. S., & Walia, H. S. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clinical rheumatology. 2013; 32(6): 895-898.[5]Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B., & Mieler, W. F. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016; 123(6): 1386-1394.[6]Melles, R. B., & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA ophthalmology. 2014; 132(12): 1453-1460.Disclosure of Interests:None declared

Sign in / Sign up

Export Citation Format

Share Document