Incidence and risk factors for acute kidney injury in head and neck cancer patients treated with concurrent chemoradiation with high-dose cisplatin

Abstract

BackgroundThree-weekly high-dose cisplatin (100 mg/m2) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Concurrent chemoradiation (CRT) with high-dose cisplatin is associated with significant acute and late toxicities, including acute kidney injury (AKI). The aims of this study were to investigate the incidence of AKI in patients with LA-SCCHN during and after treatment with high-dose cisplatin-based CRT, to identify risk factors for cisplatin-induced AKI, and to describe the impact of AKI on long-term renal function and treatment outcomes.MethodsThis is a retrospective cohort study with measurements of renal function before CRT, weekly during CRT, every 1 or 2 days during hospitalizations, and 3 and 12 months after CRT in patients with LA-SCCHN. AKI was defined as increase in serum creatinine (sCr) of ≥1.5 times baseline or by ≥0.3 mg/dL (≥26.5 μmol/L) using the Kidney Disease Improving Global Outcomes (KDIGO) classification. Logistic regression models were estimated to analyze renal function over time and to identify predictors for AKI.ResultsOne hundred twenty-four patients completed all measurements. AKI was reported in 85 patients (69%) with 112 episodes of AKI. Sixty of 85 patients experienced 1 AKI episode; 20 patients experienced ≥2 AKI episodes. Ninety-three (83%) AKI episodes were stage 1, 13 (12%) were stage 2, and 6 (5%) AKI episodes were stage 3. Median follow-up time was 29 months (Interquartile Range, IQR 22–33). Hypertension (Odds Ratio, OR 2.7, 95% Confidence Interval, CI 1.1–6.6; p = 0.03), and chemotherapy-induced nausea and vomiting (CINV; OR 4.3, 95% CI 1.6–11.3; p = 0.003) were associated with AKI. In patients with AKI, renal function was significantly more impaired at 3 and 12 months post-treatment compared to patients without AKI. AKI did not have a negative impact on treatment outcomes.ConclusionAKI occurred in 69% of patients with LA-SCCHN undergoing CRT with high-dose cisplatin. Long-term renal function was significantly more impaired in patients with AKI. Hypertension and CINV are significant risk factors. Optimizing prevention strategies for CINV are urgently needed.

Impact of Radiotherapy on Kidney Function among Patients Who Received Adjuvant Treatment for Gastric Cancer: Logistic and Linear Regression Analyses

“…Typical cisplatin-induced nephrotoxicity occurs within several days after administration and gradually recovers over two to four weeks. In a study on the head and neck cancer, serum creatinine levels were increased by ≥1.5 times or ≥0.3 mg/dL after receiving concurrent chemoradiation therapy with high-dose cisplatin (100 mg/m 2 ) in 69% of patients, even though radiotherapy was delivered to the head and neck [19]. In contrast, 60 mg/m 2 cisplatin was administered before and after radiotherapy in the present study.…”

Genome-Wide Analyses of Nephrotoxicity in Platinum-Treated Cancer Patients Identify Association with Genetic Variant in RBMS3 and Acute Kidney Injury

“…However, the retrospective character of this study inevitably led to missing variables. Clinical factors, such as malnutrition, cardiovascular status, hypoalbuminemia, and detailed information on diuretics (such as the dose and frequency) were not sufficiently documented and could therefore not be collected and analyzed in a reliable way [ 67 , 68 ]. Malnutrition in particular is very common in cancer patients due to treatment-induced nausea and mucositis, which can influence the balance of electrolytes, including magnesium.…”

Baroreflex Sensitivity Assessment Using the Sequence Method with Delayed Signals in End-Stage Renal Disease Patients

“…This process could be augmented in ESRD patients, as it is reported that they have impaired autonomic adjustments characterized by the overactive sympathetic nervous system and reduced parasympathetic modulation [ 35 ]. Although none of the patients had a previous history of malignancies, head and neck malignancies are a possible cause of BRS failure that are often missed during clinical evaluation [ 36 , 37 ].…”