title: Preoperative determinant of early postoperative renal function following radical cystectomy and intestinal urinary diversion.
abstract: OBJECTIVE
  To identify preoperative factors correlated with postoperative early renal function in patients who had undergone radical cystectomy (RC) and intestinal urinary diversion.
  
  
  METHODS
  We retrospectively identified 201 consecutive bladder cancer patients without distant metastasis who had undergone RC at our institution between 2003 and 2012. The estimated glomerular filtration rate (eGFR) was calculated using the modified Chronic Kidney Disease Epidemiology equation before RC and 3 months following RC. Univariate and stepwise multiple linear regression analyses were applied to estimate postoperative renal function and to identify significant preoperative predictors of postoperative renal function.
  
  
  RESULTS
  Patients who had undergone intestinal urinary diversion and were available for the collection of follow-up data (n = 164) were eligible for the present study. Median preoperative and postoperative eGFRs were 69.7 (interquartile range [IQR] 56.3-78.0) and 70.7 (IQR 57.3-78.1), respectively. In univariate analyses, age, preoperative proteinuria, thickness of abdominal subcutaneous fat tissue (TSF), preoperative serum creatinine level, preoperative eGFR, and urinary diversion type were significantly associated with postoperative eGFR. In a stepwise multiple linear regression analysis, preoperative eGFR, age, and TSF were significant factors for predicting postoperative eGFR (p < 0.001, p = 0.02, and p = 0.046, respectively). The estimated postoperative eGFRs correlated well with the actual postoperative eGFRs (r = 0.65, p < 0.001).
  
  
  CONCLUSIONS
  Preoperative eGFR, age, and TSF were independent preoperative factors for determining postoperative renal function in patients who had undergone RC and intestinal urinary diversion. These results may be used for patient counseling before surgery, including the planning of perioperative chemotherapy administration.
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan. gonta@tokyo-med.ac.jp.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Gondo
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.|Department of Urology, Sanno Hospital, Tokyo, Japan.|Clinical Medicine Research Center, International University of Health and Welfare, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakashima
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakagami
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tachibana
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010347:Patient Care Planning; D059035:Perioperative Period / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013223:Statistics as Topic; D001743:Urinary Bladder / Q000473:pathology / Q000503:physiopathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods
keywords: Bladder cancer; CKD-EPI; Radical cystectomy; Renal function; Subcutaneous fat tissue