Abstract: FR-PO067

AKI in Patients Treated for Cancer: A Population-Based Cohort Study

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Kitchlu, Abhijat, University of Toronto, Toronto, Ontario, Canada
  • Chan, Christopher T., University of Toronto, Toronto, Ontario, Canada
  • Kim, Joseph, University of Toronto, Toronto, Ontario, Canada
  • Wald, Ron, University of Toronto, Toronto, Ontario, Canada
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Amir, Eitan, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  • Booth, Christopher, Queen's University, Kingston, Ontario, Canada
  • Sutradhar, Rinku, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Majeed, Habeeb, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  • Nash, Danielle Marie, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
  • Garg, Amit X., Western University, London, Ontario, Canada
Background

Patients undergoing treatment for cancer are at increased risk of acute kidney injury (AKI). There are few data on AKI incidence and risk factors in the current era of treatment.

Methods

Using linked administrative datasets, we conducted a population-level cohort study of all patients initiating systemic therapy (inclusive of chemotherapy and targeted agents) for a new cancer diagnosis in Ontario, Canada from 2007 to 2014. The primary outcome was hospitalization with AKI or acute dialysis. We estimated the cumulative incidence of AKI and fitted Cox proportional hazards models (accounting for the competing risk of death), adjusting for demographics, cancer characteristics, comorbidities and co-prescriptions. We modeled exposure to systemic therapy (the 90-day period following each treatment) as a time-varying covariate. We also assessed secular trends in annual AKI incidence according to year of systemic therapy initiation.

Results

We identified 163,071 patients initiating systemic therapy, of whom 10,880 were hospitalized with AKI. The rate of AKI was 27 per 1000 person-years (PY), with 1-, 5-year and overall cumulative incidences of 3.9, 7.8 and 9.3%, respectively. Cancers with the highest 5-year AKI incidence were myeloma (26%), bladder (19%), and leukemia (15%). Advanced stage, pre-existing chronic kidney disease (CKD), and diabetes mellitus (DM) were associated with increased risk of AKI [adjusted hazard ratios (aHR) 1.41 (95%CI 1.28, 1.45), 1.80 (95%CI 1.67, 1.93) and 1.43 (95%CI 1.37, 1.50), respectively]. In patients age ≥66 years, use of diuretics and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) were associated with increased risk [aHR 1.20 (95%CI 1.14, 1.28) and 1.30 (95%CI 1.23, 1.38)]. AKI risk was significantly elevated in the 90 day period following systemic therapy exposure [aHR 2.34 (95%CI 2.24, 2.45)]. The annual incidence of AKI increased over time (from 18 to 52 per 1000-PY between 2007 and 2014).

Conclusion

Cancer-related AKI is common and associated with more advanced stage, CKD, DM and the concomitant receipt of diuretics or ACEi/ARBs. Risk is heightened in the 90 days after systemic therapy. Preventive strategies are needed to address the increasing burden of AKI in this population.