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Acute kidney injury a growing burden among patients receiving cancer therapy

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January 29, 2019

Acute kidney injury appeared to be a common and considerable burden among patients receiving systemic treatment for cancer, according to a population-based study published in Journal of the National Cancer Institute.

“Nearly 1 in 10 patients initiating systemic cancer therapy will experience a hospitalization or receive acute dialysis for acute kidney injury,” Abhijat Kitchlu, MD, FRCPC, of the department of medicine and division of nephrology at University of Toronto, and colleagues wrote. “This magnitude of acute kidney injury risk may be underappreciated by both clinicians and patients commencing systemic cancer treatment, given the paucity of existing data.”

Researchers analyzed 163,071 adults (mean age, 61.9 years; 57% women) starting systemic therapy for cancer (19% stage 4) in Ontario, Canada, between April 2007 and March 2014.

Time to first hospitalization with acute kidney injury or receipt of acute dialysis served as the primary endpoint.

Median follow-up was 1.85 years (interquartile range, 0.77-3.83).

A total of 10,880 patients in the cohort experienced acute kidney injury over 403,530 patient-years of follow-up.

Researchers observed an acute kidney injury rate of 27 per 1,000 person-years and an overall cumulative incidence rate of 9.3% (95% CI, 9.1-9.5). Annual incidence of acute kidney injury nearly tripled during the study period, from 18 to 52 events per 1,000 person-years (P for trend = < .001).

Cancers with the highest 5-year cumulative incidence of acute kidney injury were myeloma (26%; 95% CI, 24.4-27.7), bladder cancer (19%; 95% CI, 17.6-20.5) and leukemia (15.4%; 95% CI, 14.3-16.5).

Cancers with the highest HRs for acute kidney injury — after adjustment for possible cofounders and relative to breast cancer, which was the referent because it was the most common cancer among the cohort — included multiple myeloma (adjusted HR [aHR] = 4.3; 95% CI, 3.83-4.82), bladder cancer (aHR = 3.69; 95% CI, 3.28-4.16) and cervical cancer (aHR = 3.47, 95% CI, 2.9-4.14).

Patients with myeloma who received a bortezomib-based treatment regimen had a decreased risk for acute kidney injury, according to researchers. They added that the increased risk for acute kidney injury among patients with bladder and cervical cancers could be a result of exposure to nephrotoxic platinum-based chemotherapies, whereas the higher risk in leukemias and other hematological cancers may be attributable to the risks for sepsis, volume depletion and tumor lysis syndrome.

Patients also had an increased risk for acute kidney injury if they were at an advanced cancer stage (aHR = 1.41; 95% CI, 1.28-1.54). Comorbidities associated with acute kidney injury included chronic kidney disease (aHR = 1.8; 95% CI, 1.67-1.93), diabetes (aHR = 1.43; 95% CI, 1.37-1.5) and congestive heart failure (aHR = 1.36; 95% CI, 1.27-1.45).

Patients aged 66 years or older appeared at higher risk for acute kidney injury if they took a prescribed diuretic (aHR = 1.2; 95% CI, 1.14-1.28) or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (aHR = 1.3; 95% CI, 1.23-1.38). Researchers said holding or discontinuing the medications at the time of systemic therapy initiation could decrease the risk for injury.

Risk for acute kidney injury was higher among all patients in the 90-day period after systemic therapy (aHR = 2.34; 95% CI, 2.24-2.45).

Limitations of this study included a lack of serum creatinine data and a lack of data surrounding acute kidney injury among patients who were not hospitalized, which could have led to an underestimation of the overall incidence of injury.

“Considerable advances in the treatment of many cancer types have been made in the last decade, including in multiple myeloma and kidney cancers,” Kitchlu and colleagues wrote. “As such, a reassessment of [acute kidney injury] incidence across various cancer types in the current era of cancer treatment is warranted.” – by John DeRosier

Disclosures: This study was funded by the Institute for Clinical Evaluative Sciences. All study authors report no relevant financial disclosures.

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