Kidney Week

Abstract: SA-PO004

AKI in Cancer Patients: Risk Factors and Impact on Mortality

Session Information

• AKI Clinical: Epidemiology and Outcomes
  November 04, 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

• Kang, Eunjeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Eunjeong Kang,

• Park, Minsu, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Minsu Park,

• Park, Namyong, Seoul National University College of Engineering, Seoul, Korea (the Republic of)

Namyong Park,

• Park, Peong gang, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)

Peong gang Park,

• Kang, U, Seoul National University College of Engineering, Seoul, Korea (the Republic of)

U Kang,

• Kang, Hee Gyung, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Hee Gyung Kang,

• Yoon, Hyung-Jin, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Hyung-Jin Yoon,

• Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Hajeong Lee,

Background

Burden of acute kidney injury (AKI) has been demonstrated in a variety of clinical settings including surgery, intensive care unit, and exposures of nephrotoxic agents, although it remains unclear the impact of AKI on mortality in cancer patients.

Methods

We enrolled all patients who were diagnosed any type of cancer in a tertiary hospital during 10 years. Patients with double primary cancer, age less than 18 years, advanced renal dysfunction with estimated glomerular filtration rate (eGFR) <15mL/min/1.73m² were excluded. Initial serum creatinine (sCr) level was defined as first measured sCr within 2 months before and after cancer diagnosis, and baseline sCr was defined as minimum value of sCr from the previous 3 weeks by shifting the reference point every 3 weeks based on cancer diagnosis. AKI was defined according to KDIGO-AKI guideline. Demographic factors, co-morbidities, cancer type, eGFR, count of enhanced computed tomography (CT), and treatment options such as surgery and chemotherapy were included as covariates.

Results

Total 67,986 patients were included. Mean age was 56.9±13.0 years and 50.6% were male. AKI occurred in 22,990 (33.8%) of cancer patients during the follow-up period. More than half of patients (n=5,442, 23.7%) experienced 3 or more AKI events per year. Patients who developed AKI had lower eGFR at cancer diagnosis and was experienced more contrast CT exam. In multivariate logistic regression analysis, AKI developed in patients with older age, male, underlying hypertension, diabetes, lower serum albumin and hemoglobin levels, lower initial eGFR, genitourinary cancer type and receiving chemotherapy. A total of 23,140 (34.0%) deaths occurred during 48.5±40.3 months of follow-up. AKI development was demonstrated as an independent risk factor for mortality with graded response (AKI >0-3/year, hazard ratio [HR] 1.07, 95% CI 1.04-1.11, P<0.001; AKI ≥3/year, HR 2.31, 95% CI 2.20-2.43, P<0.001; reference, no AKI).

Conclusion

AKI development was common in cancer patients, especially in those with co-morbidities, impaired renal function, exposure of nephrotoxic agents such as radiocontrast and chemotherapy. Notably, AKI was an important and independent risk factors for mortality in cancer patients with dose-responsive manner.