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Kidney Week

Abstract: SA-OR108

Development and Validation of a Risk Prediction Model for AKI Following the First Course of Cisplatin

Session Information

  • What Happens After AKI
    November 04, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 05:54 PM - 06:06 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Motwani, Shveta S., Brigham and Women's Hospital and Massachusetts General Hospital, Chelsea, Massachusetts, United States
  • McMahon, Gearoid M., Brigham and Women's Hospital , Brookline, Massachusetts, United States
  • Humphreys, Benjamin D., Washington University School of Medicine, Clayton, Missouri, United States
  • Waikar, Sushrut S., Brigham and Women's Hospital and Massachusetts General Hospital, Chelsea, Massachusetts, United States
  • Curhan, Gary C., Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Cisplatin-associated acute kidney injury (C-AKI) remains a frequent problem occurring in up to 30% of patients who have received cisplatin (Cis). Candidacy for Cis has largely been determined by renal function alone. We sought to develop and validate a predictive model for C-AKI for patients who received Cis.

Methods

Clinical and demographic data were collected on patients who received Cis between 2000-2016 at two large independent cancer centers in Boston. C-AKI was defined as a 0.3mg/dl rise in creatinine from baseline to peak measurement within 14 days of the first course of Cis. Multivariable (MV) logistic regression models using C-AKI as the primary outcome were created and a scoring model was developed using one cohort (Ct). The score-based model was then tested in the validation Ct.

Results

C-AKI occurred in 13.2% of 2049 patients and 11.6% of 2362 patients after the first course of Cis in the development and validation Cts respectively. The following factors were associated with C-AKI in the development Ct: age 61-70 years (OR=1.72, 95% CI 1.26, 2.35, p=0.0007) and age 71-90 years (OR=3.21, 95% CI 2.21, 4.66, p<0.0001) when compared with age ≤60 years; Cis dose 101-150mg (OR= 1.62, 95% CI 1.16, 2.27; p=0.005) and >150mg (OR=3.77; 95% CI 2.69, 5.30; p<0.0001) when compared with ≤100mg; history of hypertension (OR= 2.24; 95% CI 1.67, 3.01; p<0.0001) when compared with no hypertension; serum albumin 2.0-3.5 g/dl (OR=1.95; 95% CI 1.39, 2.73; p=0.0001) when compared with serum albumin >3.5 g/dl; and low blood pressure within 14 days of Cis (OR=1.47; 95% CI 1.07, 2.05; p=0.02) when compared with those without low blood pressure during that interval. The c-statistics of the score-based model in the development Ct and validation Ct were 0.73 and 0.70, respectively.

Conclusion

A score-based model using the patient’s age, Cis dose, history of hypertension, serum albumin, and low blood pressure after infusion is predictive of cisplatin-associated acute kidney injury.

Frequency of C-AKI across various score ranges.