Neobladder creation in patients with chronic kidney disease: A viable diversion strategy

•Little evidence exists on renal function after urinary diversion, especially neobladders, in patients with CKD•This article analyzes the impact of continent and incontinent diversion on patients with CKD 3A and 3B•CKD 3A and 3B patients saw positive GFR change following both neobladder and conduit diversions•Patients with 3A and 3B had higher rates of hydronephrosis in both conduit and neobladder cohorts•ONB may be a viable diversion strategy in patients with lower renal function than guidelines suggest Renal function impairment is often cited as a contraindication to continent diversion strategies. There is little evidence exploring renal function changes between continent and incontinent surgery in patients with preoperative chronic kidney disease (CKD), in particular CKD3B. This was a retrospective review of two high-volume centers performing robotic assisted radical cystectomy (RARC) with orthotopic neobladder (ONB) or ileal conduit (IC) between 2014 to 2020. Patients were stratified based on CKD estimated glomerular filtration (eGFR) stage, which was estimated via the CKD-EPI equation. Postoperative renal function was compared for up to 60 months postoperative. Surgical, post-surgical, complications, and readmission data were gathered and compared between all patients 522 cystectomy patients, 430 with IC and 125 with ONB, were included. eGFR decline was statistically significant in a matched cohort of IC and ONB patients only at 3 months. There were no statistically significant differences between readmission rates, time to readmission, or complications. 34.6% of stage 3B patients had hydronephrosis on imaging prior to surgery, compared to 11.4%, 22.1% and 21.8% of CKD stage 1, 2, and 3A patients. CKD stage 3B had statistically and clinically improved eGFR through 24 months. ONB surgery may be a viable diversion strategy in patients previously thought to be contraindicated due to low renal function.