Acute Kidney Injury after Multiple Cycles of Cisplatin Chemotherapy: A Nomogram for Risk Assessment

Abstract

Introduction: Acute kidney injury (AKI) caused by cisplatin is common and has a higher incidence of multiple use, resulting in a poor short- and long-term prognosis for patients. There is currently no good premedication AKI risk assessment tool. The aim of this study was to establish an AKI risk assessment nomogram for patients with multiple cisplatin applications. Methods: This study was a retrospective analysis of patients who were treated with non-first-time cisplatin chemotherapy regimen at Changzhou Second People’s Hospital affiliated to Nanjing Medical University from January 2016 to January 2022. All data from the development group were used to screen the impact factors of AKI via univariate and multivariate analyses. A nomogram was developed based on these impact factors and verified with verification group. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curves, and decision curve analyses (DCAs) were used to evaluate the nomogram. Results: Among the 256 patients enrolled in 450 cycles of chemotherapy, 282 were in the development cohort (97 AKI), and 168 were in the validation cohort (61 AKI). Multivariate logistic regression revealed that age, hypertension, diabetes, serum cystatin C (sCysC), urinary kidney injury molecule-1 (uKim1), and a single dose of cisplatin were independently associated with AKI. The results showed that our model yielded satisfied diagnostic performance with an AUC value of 0.887 and 0.906 using the development group and on verification group. The calibration plots and DCA showed the superior clinical applicability of the nomogram. These results were verified in the validation cohort. Conclusion: A nomogram combining functional (sCysC) and tubular (uKim1) injury biomarkers with conventional clinical factors might assess the risk of AKI after multiple cycles of cisplatin chemotherapy.

Derivation and external validation of a simple risk score for predicting severe acute kidney injury after intravenous cisplatin: cohort study

“…Accurate assessment of susceptibility to CP-AKI can help clinicians weigh the risks and benefits of cisplatin, adjust the dose as needed, identify those who should be monitored more frequently, and allow researchers to enrich prospective patient cohorts (eg, for clinical trials testing novel interventions for the prevention of CP-AKI). Previous studies that investigated risk factors for CP-AKI were limited by small sample size, lack of external validation, non-contemporary data, heterogeneous definitions of acute kidney injury, and inclusion of biomarkers that are not readily available in clinical practice 131415161718. Moreover, most studies used liberal definitions of acute kidney injury based on small changes in serum creatinine levels and thus did not assess the more severe and clinically relevant manifestations of CP-AKI.…”

“…Previous studies that investigated risk factors for CP-AKI were limited by small sample size, lack of external validation, non-contemporary data, heterogeneous definitions of acute kidney injury, and inclusion of biomarkers that are not readily available in clinical practice. 13 14 15 16 17 18 Moreover, most studies used liberal definitions of acute kidney injury based on small changes in serum creatinine levels and thus did not assess the more severe and clinically relevant manifestations of CP-AKI.…”