Acute kidney injury predicts all‐cause mortality in patients with cancer

Abstract

Background Acute kidney injury (AKI) is a critical issue in cancer patients because it is not only a morbid complication but also able to interrupt timely diagnostic evaluation or planned optimal treatment. However, the impact of AKI on overall mortality in cancer patients remains unclear. Methods We conducted a retrospective cohort study of 67 986 cancer patients, from 2004 to 2013 to evaluate the relationship between AKI and all‐cause mortality. We used KDIGO AKI definition and grading system. Results During 3.9 ± 3.1 years of follow‐up, 33.8% of the patients experienced AKI at least once. Among AKI events, stage 1, 2, and 3 was 71.0%, 13.8%, and 15.1%, respectively. AKI incidence was highest in hematologic malignancies, followed by urinary tract cancer, and hepatocellular carcinoma. Male sex, older age, underlying diabetes and hypertension, lower serum albumin and plasma hemoglobin, more frequent radio‐contrast exposure, entrance of clinical trials, and receiving chemotherapy were associated with AKI occurrence. AKI development was an independent risk factor for elevated mortality in cancer patients with dose‐responsive manner (Stage 1, hazard ratio [HR] 1.183, 95% confidence interval [CI] 1.145‐1.221, P < 0.001; Stage 2, HR 1.710, 95% CI 1.629‐1.796; Stage 3, HR 2.000, 95% CI 1.910‐2.095; No AKI, reference group) even after adjustment. This tendency was reproduced in various cancer types except thyroid cancer and in various treatment modalities, however, not shown in patients with baseline renal dysfunction. Conclusion AKI was an independent risk factor for all‐cause mortality in overall cancer patients with dose‐responsive manner.

Clinical Significance of Acute Kidney Injury in Lung Cancer Patients

“…In our previous studies, we reported an unexpectedly higher incidence of AKI in lung cancer patients than other malignancies [13][14][15]. Therefore, in the present study, we aimed to determine the clinical significance of AKI in lung cancer patients with a focus on the impact on both patient and kidney prognosis.…”

“…In Korea, The Ministry of Health and Welfare generated a nationwide registry called the Korea Central Cancer Registry (KCCR), beginning in 1980, to register cancer patients and provide medical insurance benefits to them. All patients diagnosed with any type of cancer in Korea were registered on the KCCR based on the International Classification of Diseases 10th revision (ICD-10) [14].…”

“…From a total of 106,004 patients who were registered on the KCGR, we excluded patients having the following exclusion criteria after electronic medical record review: (1) aged less than 18 years, (2) registered with more than two types of cancer, (3) no measured serum creatinine (sCr) or checked only once, (4) initial estimated glomerular filtration rate (eGFR) <15 mL/min/1.73m 2 or undergoing dialysis before cancer diagnosis, and (5) no accurate data for death and follow-up duration, as previously reported [14]. Therefore, 67,986 patients were Korean Cancer Association This article is protected by copyright.…”

“…The definition of AKI was applied in the same way as in our previous study [14]. Initial sCr was defined as the first measured sCr within 2 months before or after the KCCR registration date.…”

The intersection of oncology, nephrology, and palliative care

“…6 This trend was observed in patients with baseline eGFR ⩾60 mL/ min/1.73 m 2 , while patients with eGFR 45-60 mL/ min/1.73 m 2 only had a decreased survival with KDIGO stage 2 or higher. 7 A possible explanation for the latter would be the judicious care afforded to patients with known kidney disease, including: avoidance of nephrotoxic medications and contrast, and adjustments in doses of chemotherapy administered. Taking into consideration the advanced age and altered body habitus of incident cancer patients, a normal estimated glomerular filtration rate likely overestimates kidney function, which can consequently lead to less meticulous surveillance.…”