Abstract: FR-PO263
Futility of Dialysis in Patients with Tumor Lysis Syndrome in Advanced Hematological Malignancy: A Case Series
Session Information
- Onconephrology: From AKI to CKD and Everything in Between
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Golbus, Ashley, Medical University of South Carolina, Charleston, South Carolina, United States
- Bruner, Evelyn, Medical University of South Carolina, Charleston, South Carolina, United States
- McMahon, Blaithin A., Medical University of South Carolina, Charleston, South Carolina, United States
Background
Acute kidney injury (AKI) can occur as result of tumor lysis syndrome (TLS) in patients with an underlying hematological malignancy. In TLS, hyperuricemia and hyperphosphatemia can cause crystal nephropathies. In patients with advanced malignancies, excess lactic acid production occurs as neoplastic cells preferentially undergo anaerobic glycolysis, known as the Warburg effect, resulting in type B lactic acidosis. These patients typically are hemodynamically stable. While dialysis is frequently used in the management of TLS, data on outcomes of these patients with advanced hematological malignancy would aid in deciding utility of dialysis. The purpose of our study is to assess mortality outcomes in patients with an advanced hematological malignancy with TLS, type B lactic acidosis, and AKI to better determine the utility and outcomes of dialysis in this cohort.
Methods
For this case series we used the TriNetX search, then refined our cohort to only include patients with type B lactic acidosis and excluded patients with AKI also due to hypotension/hypoperfusion. We identified 10 patients admitted to the Medical University of South Carolina between 2014 and 2022 with an underlying hematological malignancy with type B lactic acidosis, TLS, and AKI. Renal outcomes were assessed based on death, dialysis, and transfer to hospice through 6 months.
Results
Death occurred in 100% of patients with an underlying hematological malignancy presenting with TLS, type B lactic acidosis and AKI, with median time from onset of TLS to death of 4.5 days (SD 55). 70% of patients began dialysis with median time to initiation following TLS diagnosis of 1 day (SD 1.3), and median time to death following dialysis initiation of 2 days (SD 25.4). Median pH was 7.29 (SD 0.08), median lactate 8.6 (SD 5.6), LDH 5817 (SD 7558), uric acid 15.45 (SD 7.34), peak SCr 3.7 (SD 1.53), phosphorous 8.6 (SD 3.5).
Conclusion
Patients in our cohort had very poor rates of survival and dialysis did not appear to change outcomes. Given poor outcomes in these patients we suggest dialysis may have limited utility in our cohort and the focus of care should be comfort.
Figure 1. Median peak arterial pH, serum lactate, and LDH of each patient.