The effect of chronic kidney disease on adverse in-hospital outcomes after radical cystectomy with ileal conduit urinary diversion.
Michele Nicolazzini, Natali Rodriguez Pe��aranda, Fabian Falkenbach, Mattia Longoni, Andrea Marmiroli, Quynh Chi Le, Calogero Catanzaro, Zhe Tian, Jordan A Goyal, Salvatore Micali, Markus Graefen, Alberto Briganti, Gennaro Musi, Felix K H Chun, Riccardo Schiavina, Fred Saad, Shahrokh F Shariat, Carlotta Palumbo, Alessandro Volpe, Pierre I Karakiewicz
Author Information
Michele Nicolazzini: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada. michelenicolazzini@yahoo.it.
Natali Rodriguez Pe��aranda: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Fabian Falkenbach: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Mattia Longoni: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Andrea Marmiroli: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Quynh Chi Le: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Calogero Catanzaro: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Zhe Tian: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Jordan A Goyal: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Salvatore Micali: Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
Markus Graefen: Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Alberto Briganti: 6. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Gennaro Musi: Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
Felix K H Chun: Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
Riccardo Schiavina: Division of Urology, IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy.
Fred Saad: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
Shahrokh F Shariat: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Carlotta Palumbo: Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carit�� Hospital, Novara, Italy.
Alessandro Volpe: Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carit�� Hospital, Novara, Italy.
Pierre I Karakiewicz: Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montr��al Health Center, Montr��al, Qu��bec, Canada.
PURPOSE: Chronic kidney disease (CKD) is frequent in bladder cancer patients undergoing radical cystectomy (RC) with ileal conduit. However, the effect of CKD on adverse in-hospital outcomes after ileal conduit RC is not well known. METHODS: Descriptive analyses, propensity score matching (PSM), and multivariable logistic and Poisson regression models were used to address National Inpatient Sample patients treated with ileal conduit RC between 2006 and 2019. CKD severity was stratified as mild (stage II) vs. moderate (stage III) vs. severe (stage IV/V). RESULTS: Of 13,359 patients treated with RC with ileal conduit, 1973 (14.8%) had CKD. Of those, 956 (48.5%), 802 (40.6%), and 215 (10.9%) were classified as mild, moderate, or severe CKD, respectively. CKD rate increased from 4.1 to 21.9% (2006-2019, EAPC: +8.9%, p���<���0.001). CKD RC patients exhibited higher rates of adverse in-hospital outcomes in 11 of 15 categories. The absolute differences were largest for overall complications (+���13.2%), prolonged length of stay (+���7.0%), blood transfusions (+���6.0%, all p���<���0.001). After detailed multivariable adjustment, CKD was an independent predictor of 11 of 15 adverse in-hospital outcomes' categories. The detrimental effect of CKD was most pronounced for dialysis (OR 7.09), overall complications (OR 1.84), and neurological complications (OR 1.61, all p���<���0.001). Finally, a dose-response effect according to CKD severity on adverse in-hospital outcomes was observed in eight of 15 categories. CONCLUSIONS: CKD RC patients invariably exhibited higher rates of adverse in-hospital outcomes after RC with ileal conduit. In consequence this patient group should receive particularly strong consideration for preoperative optimization.
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