Cancer patients receiving systemic therapy have a high risk for acute kidney injury (AKI), including dialysis-requiring AKI (AKI-D), according to new study findings published in the Journal of the National Cancer Institute
Of 163,071 adult patients initiating chemotherapy or targeted agents for cancer during 2007 to 2014 in Ontario, Canada, 10,880 had an AKI-related hospitalization or received acute dialysis, Abhijat Kitchlu, MD, of the University of Toronto, and his colleagues reported. Overall, 9.3% of cancer therapy patients experienced AKI at a rate of 27 per 1000 person-years. From 2007 to 2014, the annual AKI incidence nearly tripled from 18 to 52 per 1000 person-years, and the annual incidence of AKI-D more than doubled, from 2.1 to 4.4 events per 1000 patient-years.
In descending order, patients with myeloma (26%), bladder cancer (19%), leukemia (15.4%), kidney cancer (13.9%), or liver cancer (11.7%) had the highest incidences of AKI over 5 years. The incidence of AKI-D, although relatively infrequent, was highest among patients with multiple myeloma (4.1%) and leukemia (2.6%).
In adjusted analyses, multiple myeloma, bladder cancer, and cervical cancer were associated with the highest AKI risk. These cancers were associated with a 4.3-, 3.7-, and 3.5-fold increased risk for AKI, respectively, compared with breast cancer (reference).
“The excess AKI risk observed in bladder and cervical cancers is likely reflective of obstructive (postrenal) AKI in these malignancies, as well as exposure to potentially nephrotoxic platinum-based chemotherapies,” Dr Kitchlu and colleagues explained. “This risk is of particular concern as AKI in the setting of bladder cancer has been linked with substantially increased risks of de novo CKD and death.”
The study identified advanced cancer stage, preexisting chronic kidney disease (CKD), diabetes, and congestive heart failure (CHF) as AKI risk factors. In adjusted analyses, patients with stage III or IV cancer had a significant 25% and 41% higher risk for AKI, respectively, compared with those who had stage I cancer. The presence of CKD, diabetes, or CHF was associated with an 80%, 43%, and 36% increased risk for AKI, respectively.
“As such, close monitoring of blood pressure and volume status in patients with congestive heart failure, CKD, and hypertension during systemic therapy is warranted,” according to the investigators. “Similarly, among patients with diabetes, hypoglycemic agents may require adjustment based on current glycemic control and kidney function.”
Certain prescription drugs also heightened risk, especially after systemic treatment. Use of a diuretic or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker was associated with 1.2 times greater AKI risk in patients older than 66 years with universal drug coverage. AKI risk more than doubled during the first 90 days following systemic therapy compared with periods after 90 days.
“Distinguishing events related to therapy (including prerenal insults and nephrotoxicity) vs direct effects of disease would be of benefit in devising cancer- and therapy-specific AKI risk reduction strategies,” Dr Kitchlu’s group stated.
Kitchlu A, McArthur E, Amir E, et al. Acute kidney injury in patients receiving systemic treatment for cancer: A population-based cohort study. J Natl Cancer Inst. DOI:10.1093/jnci/djy167