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Kidney Week

Abstract: FR-PO042

Association of Dietary Intakes with the Incidence of AKI During Chemoirradiation Using High-Dose Cisplatin in Patients with Head and Neck Cancer

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Kato, Akihiko, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
  • Nagata, Soichiro, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
  • Fujikura, Tomoyuki, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
  • Ohashi, Naro, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
  • Yasuda, Hideo, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
Background

Cisplatin (CDDP)-based chemotherapy and radiotherapy can impact on nutrition intake because of reduction of eating ability. However, it remains to be fully clarified whether changes of nutritional status is associated with the development of CDDP-induced acute kidney injury (AKI). So, we aimed this study to clarify the nutritional impact on incident AKI in head and neck cancer patients with chemoradiotherapy.

Methods

We assessed nutritional parameters and dietary intakes just before and during the chemoradiotherapy including 66-70 Gy with CDDP 80 mg/m2 on Days 1, 22 and 43 in 84 head and neck cancer patients (age: 61±10 years old, male/female=72/12). Nutritional intervention was conducted to reach the recommended intake of energy (30 kcal/kg/day) and protein (1.0-1.2 g/kg/day), considering with enteral, parenteral nutrition and oral intake. Adjustments were made during treatment, aiming to maintain stable or improving nutritional indicators.

Results

Thirty-three episodes of AKI developed in 30 patients (35.7%) during the 3 courses of CDDP administration (stage 1, N=28; stage 2; N=2, stage 3; n=3). Serum creatinine increased at the end of chemo-radiotherapy to a greater extent in AKI (0.79±0.19 to 1.16±0.38 mg/dL) than in non-AKI patients (0.73±0.18 to 0.87±0.51 mg/dL). No difference was found in basal energy (1,345±538 vs. 1,356±537 kcal/day) and protein intakes (53±21 vs. 53±22 g/day) between AKI and non-AKI patients. CDDP-based chemoradiotherapy decreased body weight (BW) by -5.6±6.4% during the therapy. A significantly greater decrease of BW was observed in AKI than in non-AKI patients (-7.5±5.9 vs. -4.6±6.4%, p<0.05). There was also a significantly lower intake of energy (909±392 vs. 1,166±421 kcal/day, p<0.05) and protein (37±0.7 vs. 46±17 g/day, p<0.05). A stepwise regression analysis revealed that energy and protein intakes and % decrease of BW at the end of treatment were significantly associated with the incident AKI (p<0.05).

Conclusion

The findings suggest that poor dietary intake during the platinum-based chemoradiation was associated with acute kidney toxicity. A more aggressive dietary support may be required to mitigate the onset of CDDP-induced AKI in patients with head and neck cancer.