Sarcopenia increased the risk of renal toxicity in bladder cancer patients: Study

A new study published in the British Journal of Urology International found that sarcopenia was linked to increased the risk of neoadjuvant chemotherapy (NAC)-associated renal toxicity in patients with muscle-invasive bladder cancer (MIBC). It may also raise the risk of renal toxicity in individuals with questionable renal function.

There is evidence that individuals with sarcopenia or muscular deficiencies may not benefit from the existing techniques of evaluating renal function using creatinine-based equations. For instance, creatinine-based estimations significantly overestimated renal function in a previous study of individuals with neurogenic lower urinary tract impairment. Therefore, Eiftu Haile and colleagues carried out this study to determine whether borderline renal function (estimated glomerular filtration rate [eGFR] 40-65 mL/min) modifies the effect of sarcopenia on neoadjuvant chemotherapy toxicity and whether sarcopenia and borderline renal function have an independent relationship with NAC toxicity risk.

All patients with MIBC who had radical cystectomies (RCs) between 2010 and 2022 and had cross-sectional imaging accessible before NAC treatment were included. Using Aquarius Intuition software, skeletal mass was calculated from axial computed tomography scans taken at the level of the L3 vertebral body. Based on agreed-upon standards of the skeletal mass index, sarcopenia was allocated. Version 5.0 of the Common Terminology Criteria for Adverse Events was used to rate the toxicity of NAC. The predictors of renal damage linked to NAC were found using binary logistic regression.

There were 216 patients in all and gemcitabine/cisplatin NAC was administered to 76% of individuals with sarcopenia (83%). A substantial risk of renal-associated NAC toxicity was linked to sarcopenia in an unadjusted model (odds ratio [OR] 4.88, 95% confidence interval [CI] 1.65-14.44; P = 0.004).

The OR for renal toxicity with sarcopenia among patients with eGFR 40-65 mL/min was 8.46 (95% CI 1.06-67.72) compared to 3.11 (95% CI 0.81-11.88) among patients with normal renal function (P = 0.43), according to an effect modification model assessing the relationship between sarcopenia and renal function.

Overall, for patients with muscle-invasive bladder cancer, neoadjuvant cisplatin-based chemotherapy is still the standard of care, followed by radical cystectomy. For individuals with MIBC, cisplatin also plays a significant role in trimodality treatment. Although a glomerular filtration rate (GFR) > 60 mL/min has historically been regarded as a cutoff for therapy, individuals with a GFR of 50–60 can still get treatment, albeit with a possibly higher risk of treatment toxicity. 

Source:

Haile, E. S., Lone, Z., Shin, D., Nowacki, A. S., Soputro, N., Harris, K., Campbell, R. A., Wood, A., Haywood, S. C., Eltemamy, M., Haber, G.-P., Weight, C. J., Wood, H. M., Taliercio, J. J., Nizam, A., Gupta, S., Remer, E. M., & Almassi, N. (2025). Sarcopenia may increase cisplatin toxicity in bladder cancer patients with borderline renal function. BJU International, 135(5), 775–781. https://doi.org/10.1111/bju.16606