Preoperative hypoalbuminemia is associated with postoperative short- and long-term renal function deterioration in patients who underwent radical cystectomy for bladder cancer

Radical cystectomy (RC), which is the standard of care for muscle-invasive and high-grade non-invasive bladder cancer, is accompanied with postoperative renal function detoriation. We aimed to evaluate the effect of hypoalbuminemia on the postoperative renal function decline after RC. A total of 272 patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/minute/1.73 m ² who underwent RC between October 2003 and December 2020 were included. Acute kidney injury (AKI) was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, while postoperative chronic kidney disease (CKD) progression was defined as eGFR < 60 mL/minute/1.73 m ² at ≥ 3 months after RC. In our cohort, 20 (7.4%) and 99 patients (36.4%) experienced AKI and CKD progression postoperatively, with a median follow-up period of 51.5 months. The median preoperative serum albumin level and eGFR were 4.1 g/dL and 82.0 mL/minute/1.73 m ² , respectively. Preoperative hypoabluminemia < 4.1 g/dL was associated with postopeative AKI (odd ratio [OR] 3.37, p  = 0.029) and CKD progression (OR 2.64, p  < 0.001) after adjusting other factors. The patients with hypoalbuminemia < 4.1 g/dL are associated with short- and long-term renal function decline after RC, suggesting that neoadjuvant chemotherapy might be considered prior to RC for these patients.