Prostate Cancer ADT Found to Boost Acute Kidney Injury Risk

Prostate cancer patients on androgen deprivation therapy (ADT) are at increased risk of acute kidney injury (AKI), according to a new study published in the Journal of the American Medical Association.

The study, by Francesco Lapi, PharmD, PhD, of Jewish General Hospital in Montreal, and colleagues included 10,250 patients with newly diagnosed nonmetastatic prostate cancer from January 1997 to December 2008. Patients were followed up until December 2009. During follow-up, the investigators identified 232 cases with a first-ever AKI admission. These cases were compared with controls matched for age, calendar year of PCa diagnosis, and duration of follow-up. Compared with never use, current use of ADT was significantly associated with a 2.5 times increased odds of AKI.

The association was mainly driven by a combined androgen blockade, estrogen only, and other combination therapies, which were associated with a 4.5 times, 4.0 times, and 4.0 times increased odds of AKI, respectively, in adjusted analyses. Oral antiandrogens only, gonadotropin-releasing hormone agonists only, and bilateral orchiectomy each was associated with about a twofold increased odds.

The finding that combination therapies were associated with the greatest odds of AKI “suggests a possible additive effect exerted by ADT on both receptor antagonism and reduction of testosterone excretion,” the authors wrote.

Dr. Lapi's group noted that to their knowledge, their study is the first population-based study to investigate the association between the use of ADT and the risk of AKI in PCa patients.

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