Abstract: FR-PO236
Kidney Replacement Therapy and Death in Patients with Hyperuricemic AKI Treated with Rasburicase
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
- Hayden, Robert Morse, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Ali, Rafia W., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Seethapathy, Ritu, Massachusetts General Hospital, Boston, Massachusetts, United States
- Strohbehn, Ian Austin, Massachusetts General Hospital, Boston, Massachusetts, United States
- Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States
- Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
Rasburicase is highly effective at rapidly lowering plasma uric acid levels in patients with cancer who develop tumor lysis syndrome and is the standard-of-care for preventing hyperuricemic AKI in this setting. However, few studies have examined the clinical outcomes of rasburicase-treated patients who already had AKI at the time of rasburicase receipt.
Methods
In this multicenter cohort study involving seven hospitals within the Mass General Brigham health care system (Boston, MA), we identified 222 adult inpatients from 2015-2020 with hyperuricemia (uric acid ≥8.0 mg/dL), active malignancy, and moderate-to-severe AKI (KDIGO stage 2 or 3) at the time of rasburicase administration. The primary outcome was kidney replacement therapy or death (KRT/death) within 7 days following rasburicase receipt. We used multivariable logistic regression to identify independent risk factors for KRT/death.
Results
A total of 83 of 222 patients (37%) progressed to KRT/death, 27 (12%) had persistent stage 2 or 3 AKI, 75 (34%) had partial or full kidney recovery, and 37 (17%) were discharged alive by day 7 (Figure). Independent risk factors for KRT/death were AKI stage 3 (odds ratio [OR] 2.11 [95% CI, 1.13-3.93]), admission to an ICU (OR 4.12 [95% CI, 1.94-8.74]), and elevated blood lactate (OR 5.10 [95% CI, 2.0-12.98] and 2.07 [95% CI, 1.05-4.10]) for lactate >5.0 and 1.3-5.0 mmol/L, respectively. The incidence of KRT/death ranged from 11% among patients with no risk factors to 81% among those with multiple risk factors.
Conclusion
Short-term clinical outcomes are poor among patients with cancer and hyperuricemic AKI treated with rasburicase, particularly among those with severe AKI, elevated blood lactate, and in the ICU. Additional data are needed to assess the efficacy of rasburicase in improving clinical outcomes in patients who already have AKI at the time of its administration.
Outcomes