title: Risk of end stage kidney disease after radical cystectomy according to urinary diversion type.
abstract: OBJECTIVE
  The risk of renal insufficiency has historically been viewed as a long-term consequence of urinary diversion after radical cystectomy. However, there are little data on the long-term rate of end stage kidney disease after urinary diversion and few studies have compared end stage kidney disease rates by diversion type. In a large, population based cohort we evaluated the risk of end stage kidney disease in patients who received an ileal conduit vs continent urinary diversion after cystectomy for bladder cancer.
  
  
  METHODS
  Using the SEER-Medicare 1992 to 2010 data set we identified 4,015 patients treated with radical cystectomy for bladder cancer, excluding those with preexisting renal disease or clinically significant preoperative hydronephrosis. The outcome of interest was end stage kidney disease stratified by diversion type. We used a Cox proportional hazard model for multivariate analysis controlling for demographic, tumor and comorbidity characteristics.
  
  
  RESULTS
  End stage kidney disease developed in 7.2% of patients, including 84% with an ileal conduit and 16% with continent urinary diversion. Median followup was 34 months (IQR 12-73). On multivariate analysis no increased risk of end stage kidney disease was associated with continent diversion (HR 1.06, 95% CI 0.78-1.44, p = 0.71). Overall the estimated risk at 5, 10 and 15 years was 8.3% (95% CI 7.1-9.5), 16.9% (95% 14.6-19.2) and 24.4% (95% CI 20.3-28.5), respectively.
  
  
  CONCLUSIONS
  No significant difference in the rate of end stage kidney disease was identified when comparing ileal conduits to continent urinary diversion. A significant risk of end stage kidney disease in the long term was identified in patients with post-cystectomy survival beyond 5 years.
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Zabell
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Oluwakayode
authors.initials: O
authors.lastname: Adejoro
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Badrinath R
authors.initials: BR
authors.lastname: Konety
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota. Electronic address: cjweight@umn.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000145:classification*; D016476:Urinary Reservoirs, Continent
keywords: chronic; cystectomy; kidney failure; risk; urinary bladder neoplasms; urinary diversion