Utilization of Pretransplant Cystography and Hydrodistention Among Anuric Patients on Renal Replacement Therapy and Its Impact on Cost and Timing of Transplantation

Abstract

Objective: To describe utilization of pretransplant cystography and hydrodistention among anuric end stage renal disease patients (ESRD) on renal replacement therapy (RRT) and its impact on cost and timing of transplantation.

Methods: A chart review was done on all anuric ESRD pretransplant patients on renal replacement therapy who underwent cystography and hydrodistention from 2014 to 2019. The authors analyzed patient demographics, post-transplant outcomes, process indicators and costs incurred due to cystography and hydrodistention.

Results: A total of 151 patients were included in the study. There was female predominance (86, 57%) with a median age of 32 (range 18-61) years. Majority of the patients underwent hemodialysis (144, 95%). Glomerulonephritis was the prevailing etiology of ESRD (119, 79%). Majority had normal bladder capacity (107, 71.5%), while 44 (29%) patients had small bladder capacity who subsequently underwent hydrodistention. There is a moderately negative correlation between bladder capacity and duration of dialysis and anuria. Hydrodistention did not significantly increase duration from diagnosis to kidney transplant (4.2 vs 3.5 months; p = .083). Median cost of cystography was Php 4377 (range 1978 – 5282) and the average total cost incurred per patient due to hydrodistention was Php 643.53.

Conclusion: Longer duration of RRT and anuria yields to lesser bladder capacity. Cystography is recommended in ESRD patients who are anuric for at least three years. Hydrodistention does not significantly prolong duration of diagnosis to kidney transplant.