Abstract: FR-PO241
Onconephrology and AKI: A University Hospital Experience
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
- Valenca, Andrea C.E.P, Hospital das Clinicas, Recife, Pernambuco, Brazil
- Oliveira, Alline, 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 prevalent in cancer patients and associated with poor outcomes. The aim of this study was to assess the clinical profile and outcomes of patients with cancer and AKI followed up in our onconephrology department.
Methods
This was a cross-sectional, retrospective study. The medical records of AKI patients were reviewed from January 2018-December 2022. AKI was diagnosed according to KDIGO. COVID-19 patients were excluded.
Results
We assessed 340 patients, 50% were male, with a median age of 62 years. The mean follow-up was 15 days. Seventy-eight percent of the patients presented with a solid tumor. The main associated cancers were: digestive tract (27.6%), cervix (15.3%) and lymphoma (12.4%). Comorbidities: hypertension (50%), diabetes mellitus (25%), and chronic kidney disease (24%). Around a third of patients were in ICU and 34% had sepsis. The AKI types were: intrinsic renal (38%), prerenal (31%) and obstructive (27%). Most patients (72%) were non-oliguric. Laboratory tests: creatinine (Cr mg/dL) on admission (CrA) 1.6 and Cr at the first nephrology visit (CrN) 2.7. Hyponatremia (sodium <135 mg/dL) was observed in 53% of patients. The median level of hemoglobin was 8.9 g/dL and albumin 2.9 g/dL. Renal replacement therapy (RRT) was required for 37% of patients. Patients on RRT differed from those who did not, by age (59 x 64; p=0.006), being in ICU (64 x 40; p<0.001), CrA (2.25 x 1.57; p=0.002), CrN (3.7 x 2.5 ; p<0.001), sepsis (50% x 24%; p<0.001), urine output (mL) (405 x 1300; p <0.001), sodium (133 x 135; p=0.034), potassium (mg/dL ) (4.8 x 4.5; p= 0.008) and phosphorus (mg/dL) (4.6 x 3.9; p<0.001). In the multivariate analysis, CrN was the only independent risk for RRT (OR 12.6, CI 2.77 – 113; p=0.005). Thirty-five percent of patients died, and mortality was higher in those who underwent RRT (56% vs. 22%, p<0.001). Only 26% of patients fully recovered and 4% remained on RRT.
Conclusion
AKI in cancer patients is associated with high mortality. The clinical profile of cancer patients is unfavorable, with a high prevalence of hyponatremia, anemia and malnutrition. A late referral to a nephrologist is associated with higher rate of RTT and a poor prognosis.