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Kidney Week

Abstract: TH-PO068

AKI in Hospitalized Patients with Solid Organ Cancer Who Undergo Cancer Treatment

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Camargo, Marianne, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Zheng, Yuanchao, Stanford University, Palo Alto, California, United States
  • Stedman, Margaret R., Stanford University, Palo Alto, California, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
Background

Acute Kidney Injury (AKI) is common in patients with cancer and associated with interruptions in therapy, increased testing and procedures, and higher healthcare costs. However, the epidemiology of AKI complicating solid organ cancer is not well-understood. We aimed to explore correlates and consequences of AKI in patients hospitalized for treatment of solid organ cancer in the United States.

Methods

Using the National Inpatient Sample (NIS) database from 2012 we included patients over the age of 20 with a primary diagnosis of solid organ cancer with a concomitant diagnosis code for cancer treatment category (surgery, chemotherapy or radiation). We excluded patients with a diagnosis code for end-stage renal disease (ESRD), or if they had a procedure code for dialysis without associated AKI. In our analysis we created separate models for the interaction between cancer type and treatment category and the outcomes: AKI, hospitalization length of stay (LOS) and cost. Multivariate models were adjusted for age, sex, comorbidities, region, primary payer, bedsize and teaching status of the hospital.

Results

The weighted sample had 321,345 hospital admissions for solid organ cancer treatment. Approximately half were for women and >60% were for persons over the age of 60. More than half had hypertension, more than one in five had diabetes. Overall, 5.5% of patients who underwent surgical treatment had AKI, compared to 11% and 9% of patients who received chemotherapy and radiation therapy (XRT) respectively. After adjustment for covariates, patients with the highest risk of AKI were those admitted for kidney and liver cancer XRT who had a 32% (CI 13%-50%), and 23% (CI 7%-40%) probability of AKI respectively, followed by admissions for XRT of colon cancer 19% (CI 11%-27%), and chemotherapy for prostate cancer 18% (CI 2%-34%). After adjusting for cancer type, treatment type, and covariates, hospitalizations with AKI had on average, double LOS (CI 1.92-2.11) and 1.78 times higher hospitalization costs (CI 1.70-1.86).

Conclusion

The probability of AKI in hospitalized patients with solid organ cancer is significantly different among different cancer types and treatment modalities. Presence of AKI is associated with increases in hospitalization costs and LOS. Further analysis will evaluate risk factors and inform clinical decision making.