AKI Hinders Remission in Patients with Hematologic Cancers
Acute kidney injury (AKI) is common among patients with newly diagnosed high-grade hematologic malignancies and it decreases the likelihood of achieving complete remission, a French study found. It also increases the risk of death.
Emmanuel Canet, MD, of Saint-Louis University Hospital in Paris, and colleagues prospectively collected data on 200 patients with newly diagnosed high-grade non-Hodgkin lymphoma (53.5% of patients), acute myeloid leukemia (29%), acute lymphoblastic leukemia (11.5%), and Hodgkin disease (6%). Of these 200 patients, 137 (68.5%) had AKI according to RIFLE criteria. Patients with AKI had significantly lower six-month rates of complete remission (39.4% vs. 68.3%) and a significantly higher mortality rate (47.4% vs. 30.2%) than patients without AKI, according to an online report in PLoS One.
Ninety-one percent of AKI cases were due to five causes: hypoperfusion (66 patients, 48.2%), tumor lysis syndrome (TLS; 60 patients, 43.8%), tubular necrosis (39 patients, 28.5%), nephrotoxic agents (28 patients, 20.4%), and hemophagocytic lymphohistiocytosis (20 patients, 14.6%).
“Importantly, our study shows that the etiology influences the prognostic significance of AKI,” the authors stated. They noted that patients with AKI due only to TLS had the same likelihood of being in complete remission after six months as did patients without AKI. “This finding is not surprising, as TLS is a marker for good tumor response to chemotherapy.”
“Early intensive management including nephrotoxic drug withdrawal, adequate assessment and prevention of TLS, and early administration of specific treatments might improve patient outcomes when combined with aggressive supportive care,” the authors concluded.