Use of Androgen Deprivation Therapy for Treatment of Prostate Cancer Associated with Increased Risk of Acute Kidney Injury
In a study that included more than 10,000 men with nonmetastatic prostate cancer, use of androgen deprivation therapy was associated with a significantly increased risk of acute kidney injury, with variations observed with certain types of androgen deprivation therapies, according to a study in the July 17 issue of JAMA, published online today.
Although androgen deprivation therapy is traditionally reserved for patients with advanced prostate cancer, the authors noted that it is increasingly being used in patients with no evidence of metastatic disease. Despite its beneficial effects on prostate cancer progression, androgen deprivation therapy is associated with serious adverse events during treatment and may lead to hypogonadism, which could potentially lead to acute kidney injury. Patients with acute kidney injury have a mortality rate of around 50%.
Study Details
Francesco Lapi, PharmD, PhD, of Jewish General Hospital, Montreal, Canada, and colleagues conducted a study to determine whether the use of androgen deprivation therapy was associated with an increased risk of acute kidney injury in patients newly diagnosed with prostate cancer. The researchers used medical information extracted from the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database. The study included men newly diagnosed with nonmetastatic prostate cancer between January 1997 and December 2008 who were followed up until December 2009. Patients had incident acute kidney injury during follow-up and were randomly matched with up to 20 controls on age, calendar year of prostate cancer diagnosis, and duration of follow-up.
Analysis was conducted to estimate the odds ratios of acute kidney injury associated with the use of androgen deprivation therapy. Patients were categorized into one of six mutually exclusive groups, depending on their specific types of androgen deprivation therapy: gonadotropin-releasing hormone agonists, oral antiandrogens, combined androgen blockade, bilateral orchiectomy, estrogens, and a combination of the above.
Outcomes
A total of 10,250 patients met the study inclusion criteria. During follow-up, 232 cases with a first-ever acute kidney injury admission were identified. All cases were matched with at least one control. The researchers found that compared with "never use," current use of androgen deprivation therapy was significantly associated with a 2.5 times increased odds of acute kidney injury (odds ratio = 2.48, 95% confidence interval [CI] = 1.61–3.82). According to the study, this association was mainly driven by a combined androgen blockade consisting of gonadotropin-releasing hormone agonists with oral antiandrogens, estrogens, other combination therapies, and gonadotropin-releasing hormone agonists,
The authors concluded, “The use of androgen deprivation therapy was associated with an increased risk of acute kidney injury, with variations observed with certain types of androgen deprivation therapies. This association remained continuously elevated, with the highest odds ratio observed in the first year of treatment. Overall, these results remained consistent after conducting several sensitivity analyses.”
For full disclosures of the study authors, visit jama.jamanetwork.com.
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