Risk Factors for Developing Metabolic Acidosis after Radical Cystectomy and Ileal Neobladder

• Published in: PloS one Vol. 11; no. 7; p. e0158220
• Main Authors: Kim, Kwang Hyun, Yoon, Hyun Suk, Yoon, Hana, Chung, Woo Sik, Sim, Bong Suk, Ryu, Dong-Ryeol, Lee, Dong Hyeon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.07.2016; Public Library of Science (PLoS)
• Subjects: Acidosis; Acidosis - etiology; Adenosine triphosphatase; Aged; Bicarbonate; Bicarbonates; Bicarbonates - blood; Biology and Life Sciences; Bladder; Bladder cancer; Cancer; Carbonates; Catheters; Cohort Studies; Cystectomy; Cystectomy - adverse effects; Development and progression; Diabetes; Diabetes mellitus; Electrolytes; Female; Gene expression; Glomerular Filtration Rate; Health risks; Humans; Laboratories; Male; Medicine; Medicine and Health Sciences; Metabolic acidosis; Metabolism; Middle Aged; Multivariate Analysis; Patient outcomes; Patients; Physical Sciences; Physiological aspects; Reconstruction; Regression analysis; Renal function; Risk analysis; Risk Factors; Rodents; Surgery; Time Factors; Treatment Outcome; Urinary Bladder - surgery; Urinary Bladder Neoplasms - surgery; Urinary Diversion - adverse effects; Urine; Urologic surgery; Urology; South Korea; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0158220

To investigate the serial changes of metabolic acidosis and identify associated risk factors in patients who underwent radical cystectomy and ileal neobladder. From January 2010 to August 2014, 123 patients who underwent radical cystectomy and ileal neobladder reconstruction for bladder cancer were included in this study. Metabolic acidosis was defined as a serum bicarbonate level less than 22 mEq/L and impaired renal function was defined as a GFR <50ml/min. The presence of metabolic acidosis was evaluated at 1 month, 1 year, and 2 years after surgery. Multivariate logistic regression analysis was conducted to identify risk factors associated with development of metabolic acidosis. Metabolic acidosis was observed in 52%, 19.5%, and 7.3% of patients at 1 month, 1 year, and 2 years after surgery, respectively. At 1 month after surgery, impaired renal function was the only independent risk factor associated with metabolic acidosis (OR 3.87, P = 0.046). At 1 year after surgery, diabetes was the only independent risk factor associated with metabolic acidosis (OR 5.68, P = 0.002). At 2 years post-surgery, both age and diabetes were significant risk factors associated with metabolic acidosis. Approximately, half of patients experienced metabolic acidosis one month after ileal neobladder reconstruction. Preoperative impaired renal function was the most significant risk factor for developing metabolic acidosis in the early postoperative period. However, the incidence of metabolic acidosis decreased to less than 20% 1 year after surgery, and diabetes was an independent risk factor during this period.