Abstract: FR-PO248
Mortality of Patients with Cancer and AKI: What Are the Lessons?
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
- Oliveira, Alline, Hospital das Clinicas, Recife, Pernambuco, Brazil
- Valenca, Andrea C.E.P, Hospital das Clinicas, Recife, Pernambuco, Brazil
- Nascimento, Joseph Lopes, Hospital das Clinicas, Recife, Pernambuco, Brazil
- Lacerda, Thiago Martins, Hospital das Clinicas, Recife, Pernambuco, Brazil
- Feijo de Melo, Klebson Fellipe, Hospital das Clinicas, Recife, Pernambuco, Brazil
- Alves, Italo Rafael Correia, Hospital das Clinicas, Recife, Pernambuco, Brazil
- Gueiros, Ana Paula, Hospital das Clinicas, Recife, Pernambuco, Brazil
Background
Acute kidney injury (AKI) is a prevalent complication in cancer patients, contributing to mortality. This study aimed to assess factors associated with the mortality of patients with cancer and AKI monitored in the onconephrology clinic of a university hospital.
Methods
This was a cross-sectional, retrospective study. Medical records were reviewed of patients monitored from January 2018 to December 2022. Patients with COVID-19 were excluded. AKI was defined according to KDIGO criteria. The final creatinine (CrF mg/dL): last value measured before discharge or death; oliguria: diuresis <400 mL/24h. A comparative analysis was performed of patients who died and survivors. Univariate and multivariate analyzes were used in the search for risk factors for death. The impact was assessed of hyperphosphatemia (phosphorus>4.5mg/dL) and hyponatremia (sodium<135mEq/L) on mortality.
Results
A total of 340 patients (50% male), with a median age of 62 years, were studied. The mean follow-up time was 15 days. Most patients (78%) presented solid tumors. Types of AKI were: intrinsic renal (38%), prerenal (30%), and obstructive (27%). Outcome data were available on 336 patients. One hundred and eighteen patients (35%) died. Patients who died differed from survivors by being in ICU (55% x 17%; p<0.001), intrinsic renal AKI (57% x 27%; p<0.001), sepsis (58% x 19%; p<0.001), urine output (mL) (500 x 1050; p<0.001), need for renal replacement therapy (RRT) (60% x 25%; p<0.001), CrF (3.2 x 1.5; p<0.001), phosphorus (4.6 x 4.0; p=0.018) and albumin (g/dL) (2.8 X 3.0; p=0.046). In the univariate analysis, the following were associated with mortality: not being in ICU (OR 0.17; p<0.001), CrF (OR 2.26; p<0.001), intrinsic renal AKI (OR 3.47; p<0.001), no sepsis (OR 0.17; p<0.001), non- oliguric (OR 0.31; p<0.001), phosphorus (OR 1.2; p=0.023) and no need for RRT (OR 0.22; p<0.001). In the multivariate analysis, only CrF was an independent risk factor for death (OR 7.51; p=0.009). Hyperphosphatemia was associated with mortality (p=0.006), but hyponatremia was not (p=0.8).
Conclusion
We confirmed the high mortality rate of patients with cancer and AKI. The severity and persistence of AKI are determinants of mortality.
Hyperphosphatemia seems to be a predictor of mortality in cancer patients with AKI.