Abstract: SA-PO207
Dialysis Does Not Affect Outcomes in Stage IV Cancer Patients Admitted to the Intensive Care Unit with AKI at a Comprehensive Cancer Center
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
Authors
- Abudayyeh, Ala, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Abdelrahim, Maen, Houston Methodist Cancer Center, Houston, Texas, United States
- Song, Juhee, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Mandayam, Sreedhar A., University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Nates, Joseph L., University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Moss, Alvin H., West Virginia University, Morgantown, West Virginia, United States
Background
In advanced cancer patients, prolongation of life with treatment may incur substantial emotional and financial expense. Since acute kidney injury (AKI) in hospitalized cancer patients is known to be associated with poor survival, we investigated whether dialysis use in the intensive care unit (ICU) was a significant independent predictor of higher mortality or worse outcomes.
Methods
We retrospectively reviewed patients admitted in 2005-2014 who were diagnosed with stage IV solid tumors, had acute kidney injury and a nephrology consult. The main outcomes were survival from ICU admission, inpatient mortality and long-term survival after hospital discharge. Log-rank tests and Cox proportional regression were used to compare survival between dialysis and non-dialysis groups. Propensity score matched landmark survival analyses was performed with two landmark time-points chosen at day 2 and at day 7 from ICU admission.
Results
Of 465 patients, 176 needed renal replacement therapy. Landmark analyses at day 2 and day 7 indicated need for dialysis was not associated with worse mortality during ICU admission (HR, 0.926, p=0.6657), adjusting for age, baseline serum albumin, baseline creatinine, baseline, and baseline max SOFA. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum SOFA, the patients who received dialysis were not less likely to be discharged alive than non-dialysis patients (p=0.9892). To evaluate the impact of dialysis on longer-term survival we evaluated 189 patients who were discharged alive. There was not a longer-term survival benefit after discharge for patients who received dialysis.
Conclusion
Our study found that receiving dialysis in the ICU did not adversely affect survival to discharge and longer-term survival after discharge for patients with stage IV cancer with AKI. Dialysis itself contributed little harm or benefit to survival after discharge of the patient. Prolongation of suffering with no meaningful longer-term survival should always be included in the shared decision-making discussion prior to reaching a decision about the initiation of dialysis in stage IV cancer patients with acute kidney injury.
Funding
- Other NIH Support