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In a Canadian population–based cohort study reported in the Journal of the National Cancer Institute, Kitchlu et al found that acute kidney injury (AKI) is common in patients receiving systemic therapy for newly diagnosed cancer and has increased in incidence in recent years.
The study involved data from all patients starting systemic therapy with chemotherapy or targeted agents for newly diagnosed cancer between 2007 and 2014. The primary outcome measure was hospitalization with AKI or acute dialysis.
AKI Incidence and Risk Factors
Among 163,071 patients initiating systemic therapy, 10,880 experienced AKI. The rate of AKI was 27 cases per 1,000 person-years, with an overall cumulative incidence of 9.3%. The highest 5-year incidence rates for AKI were associated with multiple myeloma (26.0%), bladder cancer (19.0%), and leukemia (15.4%). Advanced cancer stage (adjusted hazard ratio [aHR] = 1.41, 95% confidence interval [CI] = 1.28–1.54), chronic kidney disease (aHR = 1.80, 95% CI = 1.671.93), and diabetes (aHR = 1.43, 95% CI = 1.37–1.50) were associated with increased risk of AKI on multivariate analysis. The annual incidence of AKI increased from 18 to 52 cases per 1.000 person-years between 2007 and 2014.
Among patients aged ≥ 66 years with universal drug benefits, use of diuretics (aHR = 1.20, 95% CI = 1.14–1.28) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (aHR = 1.30, 95% CI = 1.23–1.38) were associated with increased risk of AKI. Risk of AKI was higher during the 90-day period following systemic therapy vs > 90 days (aHR = 2.34, 95% CI = 2.24–2.45).
The investigators concluded, “Cancer-related AKI is common and associated with advanced cancer stage, chronic kidney disease, diabetes, and concomitant receipt of diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Risk is heightened in the 90 days after systemic therapy. Preventive strategies are needed to address the increasing burden of AKI in this population.”
Abhijat Kitchlu, MD, of the University of Toronto, Toronto General Hospital, is the corresponding author for the Journal of the National Cancer Institute article.
Disclosure: The study was supported by the Institute for Clinical Evaluative Sciences (ICES) Western site. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The study authors’ full disclosures can be found at academic.oup.com.
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