The characteristics and risk factors for cisplatin-induced acute kidney injury in the elderly

Abstract

ObjectivesThe most serious adverse reaction of cisplatin is acute kidney injury (AKI). Cisplatin-induced acute kidney injury (CIA) has no specific preventive measures. This study aims to explore the characteristics and risk factors for CIA in the elderly and to identify potential methods to reduce CIA.Materials and methodsPatients ≥18 years old, with primary tumors, who received initial cisplatin chemotherapy and whose serum creatinine (SCr) values were measured within 2 weeks pre- and postcisplatin treatment and who had complete medical records, were selected from a single center from January 1, 2013 to December 31, 2015. The exclusion criteria included radiotherapy or surgery, recurrent tumors, previous cisplatin treatment, lack of any SCr values before or after cisplatin therapy, and incomplete medical records.ResultsOut of a total of 527 patients, 349 were elderly. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use (9.2%) was more prevalent in the elderly than in younger patients (2.8%, p = 0.007). The dosage of cisplatin treatment was lower in the elderly, but the incidence of CIA (9.46%) was higher in the elderly than in younger patients (3.37%). There were significant differences in the SCr levels, estimated glomerular filtration rate, ACEI/ARB use, and whether a single application of cisplatin was administered, between the elderly AKI group and the non-AKI group. Multivariable analysis showed that administration of a single application of cisplatin (OR 2.853, 95% CI: 1.229, 6.621, p = 0.015) and ACEI/ARB use (OR 3.398, 95% CI: 1.352, 8.545, p = 0.009) were predictive factors for developing CIA in the elderly.ConclusionThe incidence of CIA in the elderly was higher than in younger patients. ACEI/ ARB usage and administration of a single application of cisplatin were independent risk factors for CIA in the elderly.

Evaluation of Acute Kidney Injury Associated With Anticancer Drugs Used in Gastric Cancer in the Japanese Adverse Drug Event Report Database

“…32,33 Renin-angiotensin system (RAS) inhibitors, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), are commonly prescribed as antihypertensive drugs. RAS inhibitors are known to cause acute prerenal failure; Liu et al 34 reported that the concomitant use of ACE inhibitor/ARB is an independent risk factor for CDDP-induced AKI. These facts might explain why hypertension is a candidate risk factor of CDDP-related AKI in our study.…”

Systemic complications of the bidirectional intraoperative chemotherapy with intravenous ifosfamide and hyperthermic intraperitoneal chemotherapy (HIPEC) using cisplatin plus doxorubicin

“…The discrepancy between this and our nephrotoxicity rate may be at least due to our higher percentage of elderly patients (age >65 years) (27.7% in our study versus 0% in the Van der Speeten study). Elderly patients are more susceptible to chemotherapy-induced nephrotoxicity [24]. However, age should not act as a contraindication for performing HIPEC [25].…”

Losartan risk for female in cisplatin-induced nephrotoxicity

“…[1] in their cohort study concluded that “Lower blood pressure and the use of renin-angiotensin system inhibitors were associated with the incidence of cisplatin nephrotoxicity” while Liu et al . [2] in their study mentioned that “Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker usage and administration of a single application of cisplatin were independent risk factors for cisplatin-induced acute kidney injury in the elderly.”…”