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. 2020 Sep 30;10(1):16145.
doi: 10.1038/s41598-020-73191-0.

Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer

Mathieu Rouanne  1   2 , François Gaillard #  3 , Matthias E Meunier #  4 , Yanish Soorojebally  4   5 , Hoang Phan  6 , Hind Slimani-Thevenet  7 , Anne-Sophie Jannot  6 , Yann Neuzillet  4   5 , Gérard Friedlander  3   8   9 , Marc Froissart  10 , Henry Botto  4 , Pascal Houillier  3   8   11 , Thierry Lebret  4   5 , Marie Courbebaisse  3   7   8
Affiliations

Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer

Mathieu Rouanne et al. Sci Rep. .

Erratum in

Abstract

Precise determination of glomerular filtration rate (GFR) is essential for the management of patients with muscle-invasive bladder cancer (MIBC). We aim to describe the early evolution of measured GFR (mGFR) after radical cystectomy and urinary diversion (RCUD) and to identify risk factors for GFR decline. GFR measurement using 51Cr-EDTA continuous infusion, estimated GFR (eGFR) from five published equations and renal scintigraphy with split renal function determination were performed before and 6 months after RCUD. Chronic Kidney Disease (mGFR < 60 mL/min/1.73 m2) and GFR stages were defined according to the KDIGO guidelines using mGFR. Twenty-seven patients (men 85%, median age 65, IQR 59; 68 years) were included. A total of 20 (74%) patients experienced significant mGFR decline at 6 months postoperatively. Median mGFR decreased from 84.1 pre-operatively (IQR 65.3; 97.2) to 69.9 mL/min/1.73 m2 (IQR 55.0; 77.9) 6 months after surgery (p < 0.001). Thirteen (48%) patients had a progression to a worse GFR stage. Of the 22 patients without pre-operative CKD, 5 (23%) developed post-operative CKD. Diabetes mellitus was more frequent in patients in the highest tertile of relative mGFR decline (44% vs. 11%, p = 0.02) and platinum-based adjuvant chemotherapy tended to be more frequently used in these patients (44% vs. 17%, p = 0.06). Importantly, pre-operative weight was independently and negatively associated with post-operative mGFR and with mGFR slope in multivariable analyses. In this prospective series, we demonstrated that early and significant mGFR decline occurred after RCUD and perioperative platinum-based chemotherapy, especially in patients with diabetes mellitus and overweight.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the study. RC radical cystectomy, UD urinary diversion, GFR glomerular filtration rate, LN lymph nodes.
Figure 2
Figure 2
Individual evolution of measured glomerular filtration rate (mGFR in mL/min/1.73 m2) before and 6 months after radical cystectomy and urinary diversion. Black bars: mGFR before surgery. Grey bars: mGFR after surgery. Dotted lines represents mGFR at 60 mL/min/1.73 m2 (cut-off for chronic kidney disease definition) and at 30 mL/min/1.73 m2 (cut-off between stages 3B and 4 for GFR staging).
Figure 3
Figure 3
Scatter plot showing the relationship between eGFR and mGFR values ((A) preoperative values; (B) postoperative values).
See this image and copyright information in PMC

References

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