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Kidney Week

Abstract: SA-PO197

AKI in Patients with Haematological and Solid Organ Malignancy Receiving Chemotherapy

Session Information

  • Onco-Nephrology: Clinical
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Author

  • Shettigar, Reshma, Dunedin public Hospital, Dunedin, New Zealand
Background

The aim of this study was to look at the incidence of acute kidney injury and its clinical correlates in patients with haematological and solid organ malignancies receiving chemotherapy.

Methods

All patients, more than 18 years of age receiving outpatient chemotherapy for solid organ and haematological malignancies at our hospital from Jan 2016 to Dec 2016. Incidence of acute kidney injury was computed and its causes and clinical correlates were analyzed using univariate analysis and multivariate analysis.

Results

592 patients were included in the study. Acute kidney injury during the one-year course of chemotherapy was seen in 158 patients (27.24%). Pre-renal acute kidney injury was seen in 82 patients (51.8%) and intrinsic renal in 20 patients (12.65%) and post renal cause in 35 patients (22.15%). Sepsis was the most common cause of acute kidney injury, followed by hypovolumia . There were 13 patients where the acute kidney injury was attributed to drugs. The drugs were NSAIDS, Lenalidomide, Methotrexate, Ibrutinib, Pamidronate, Gemcitabine, Vemurafinib and Crizotinib. Patients with acute kidney injury attributed to above drugs had either a dose reduction or change in chemotherapy regimen. None of the patients had a renal biopsy to confirm drug-induced pathology. However all of the patients had resolution of AKI after stopping the drug or changing the regimen. Also of note, only one patient with Pamidronate induced acute kidney injury was referred to nephrology service. Looking at individual cancer types, 5 out of 10 patients (50%) with RCC developed acute kidney injury followed by lymphoma ,prostate and myeloma . Factors associated with acute kidney injury, higher ECOG score, diabetes and hypertension were associated with higher risk of developing acute kidney injury. Contrast to other published papers, having metastatic disease and ACE inhibitors was not associated with higher risk of acute kidney injury. Acute kidney injury is associated with increased mortality. We observed the same trend in our study. Without adjusting for confounding factors, mortality in the acute kidney group at 6, 12 and 18 months was 15%, 31% and 46% compared to Non AKI group, which was 5%, 26% and 43%.

Conclusion

AKI is common in patients with malignancies and its associated with high mortality.