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

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...

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Autores principales:	Mathieu Rouanne, François Gaillard, Matthias E. Meunier, Yanish Soorojebally, Hoang Phan, Hind Slimani-Thevenet, Anne-Sophie Jannot, Yann Neuzillet, Gérard Friedlander, Marc Froissart, Henry Botto, Pascal Houillier, Thierry Lebret, Marie Courbebaisse
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1025189b6e0d493eb1bc396af9eeb6b1
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spelling	oai:doaj.org-article:1025189b6e0d493eb1bc396af9eeb6b12021-12-02T18:51:14ZMeasured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer10.1038/s41598-020-73191-02045-2322https://doaj.org/article/1025189b6e0d493eb1bc396af9eeb6b12020-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-73191-0https://doaj.org/toc/2045-2322Abstract 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.Mathieu RouanneFrançois GaillardMatthias E. MeunierYanish SoorojeballyHoang PhanHind Slimani-ThevenetAnne-Sophie JannotYann NeuzilletGérard FriedlanderMarc FroissartHenry BottoPascal HouillierThierry LebretMarie CourbebaisseNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-10 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mathieu Rouanne François Gaillard Matthias E. Meunier Yanish Soorojebally Hoang Phan Hind Slimani-Thevenet Anne-Sophie Jannot Yann Neuzillet Gérard Friedlander Marc Froissart Henry Botto Pascal Houillier Thierry Lebret Marie Courbebaisse Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer
description	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.
format	article
author	Mathieu Rouanne François Gaillard Matthias E. Meunier Yanish Soorojebally Hoang Phan Hind Slimani-Thevenet Anne-Sophie Jannot Yann Neuzillet Gérard Friedlander Marc Froissart Henry Botto Pascal Houillier Thierry Lebret Marie Courbebaisse
author_facet	Mathieu Rouanne François Gaillard Matthias E. Meunier Yanish Soorojebally Hoang Phan Hind Slimani-Thevenet Anne-Sophie Jannot Yann Neuzillet Gérard Friedlander Marc Froissart Henry Botto Pascal Houillier Thierry Lebret Marie Courbebaisse
author_sort	Mathieu Rouanne
title	Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer
title_short	Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer
title_full	Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer
title_fullStr	Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer
title_full_unstemmed	Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer
title_sort	measured glomerular filtration rate (gfr) significantly and rapidly decreases after radical cystectomy for bladder cancer
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/1025189b6e0d493eb1bc396af9eeb6b1
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Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer

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