Cancer-related AKI affects nearly 1 in 10 patients

  • Kitchlu A & al.
  • J Natl Cancer Inst
  • 13 Nov 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Cancer-related acute kidney injury (AKI) affects nearly 1 in 10 patients.
  • Risk appears heightened within 90 days of systemic therapy.

Why this matters

  • Study sheds light on AKI burden and risk factors in this population.

Study design

  • Canadian population-based study of 163,071 newly diagnosed adults (mean age, 61.89 years) initiating systemic cancer therapy (chemotherapy/targeted agents) during 2007-2014.
  • Funding: Institute for Clinical Evaluative Sciences.    

Key results

  • 10,880 (6.7%) required hospitalization/dialysis for AKI.
    • Incidence rate, 27 per 1000 person-years (PY).
    • Annual incidence increased from 2007 to 2014 (18-52 per 1000 PY).
    • Cumulative incidence, 9.3% (95% CI, 9.1%-9.6%).
  • AKI risk was exacerbated in the first 90 days after systemic therapy (aHR=2.34; P<.001>
  • Median time from most recent systemic therapy exposure to AKI, 33 (interquartile range, 9-177) days.
  • Malignancies with highest 5-year AKI incidence:
    • Myeloma: 26.0% (95% CI, 24.4%-27.7%).
    • Bladder cancer: 19.0% (95% CI, 17.6%-20.5%).
    • Leukemia: 15.4% (95% CI, 14.3%-16.5%).
  • Risk factors included advanced cancer stage (aHR=1.41), chronic kidney disease (aHR=1.80), and diabetes (aHR=1.43, all P<.001>
  • Among older patients (age ≥66 years) with universal drug benefits, AKI risk rose with concomitant use of:
    • Diuretics: aHR=1.20 (P<.001>
    • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): aHR=1.30 (P<.001>

Limitations

  • Less-severe AKI not captured.
  • Potential confounding from comorbidities.

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