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Kidney Week

Abstract: PO0029

A Retrospective Cohort Study of Chemotherapy-Related AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Kang, Xin, Renal Division, Peking University First Hospital, Peking University, Beijing, China
  • Yang, Li, Renal Division, Peking University First Hospital, Peking University, Beijing, China
Background

Chemotherapy-related acute kidney injury (CR-AKI) is increasing with the growing number of cancer patients and the development of chemotherapeutic agents, whereas systemic information about CR-AKI is still limited.

Methods

This is a multicenter retrospective cohort study of cancer patients with CR-AKI screened from a cohort of hospital-acquired adult AKI patients based on a nationwide AKI survey in China. The enrolled CR-AKI patients were divided into three groups according to peak AKI stages (1 to 3) during hospitalization. The primary outcome was all-cause death in hospital, and the secondary outcome was AKI recovery.

Results

Of 3,468 adult inpatients with hospital-acquired AKI identified basing on the China nationwide AKI survey, 258 patients with CR-AKI were enrolled in our study, of which 20.1% (52/258) were ≥ 70 years old. A total of 413 person-time chemotherapeutic agents were related to AKI, of which platinum compounds (24.5%, 101/413) were the most common ones, followed by fluoropyrimidines (13.1%, 54/413), and anthracyclines (9.2%, 38/413). Among the 258 CR-AKI patients, 61 (23.0%) reached AKI stage 3, and 12 (4.7%) received RRT. The in-hospital mortality was 14.7% (38/258). Of the 207 surviving patients with a reliable serum creatinine value at discharge, 48.3% (100/207) failed to renal recovery. AKI stage 3 remained the independent risk factor for in-hospital death (OR 2.930, 95%CI 1.156~7.427) after adjustment for gender, age, comorbidities, and medications. It is surprising to note that, although patients of AKI stage 1 had lower levels of SCr both at peak and at discharge compared to patients with AKI stage 2 or 3, there was a higher proportion of patients of AKI stage 1 not achieving renal function significantly improved at discharge (failure to recover) compared to those of AKI stage 2 or 3 (57.1% vs. 41.4% vs. 36.4%, P = 0.032). More importantly, a lot more AKI episodes were not recognized or diagnosed by physicians in charge in patients of AKI stage 1 compared to the other two groups (82.8% vs. 60.0% vs. 36.1%, P < 0.001).

Conclusion

CR-AKI accounted for a considerable proportion of hospital-acquired AKI. Severe CR-AKI increases in-hospital mortality. Mild CR-AKI that overlooked by physicians yet sustained kidney injury was common in these patients. Recognizing CR-AKI at an early stage and making personalized treatment should be emphasized when offering chemotherapy to patients.