Abstract: SA-PO1251
Does Kidney Replacement Therapy Improve Outcomes in Patients with Stage IV Metastatic Cancer? A 17-Year Retrospective Cohort Study
Session Information
- Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Khanna, Soumya, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
- Won, Alice H., Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States
- Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States
Background
Patients with stage IV metastatic solid tumors face heightened risk of acute kidney injury (AKI) due to nephrotoxicity, sepsis, urinary obstruction, and hemodynamic compromise. Despite increasing utilization of renal replacement therapy (RRT) in oncologic critical care, outcomes data in this population remain limited. We sought to characterize short- and long-term outcomes among stage IV metastatic solid cancer patients requiring RRT and to identify factors associated with in-hospital mortality.
Methods
Retrospective cohort study of adults with stage IV metastatic solid malignancy admitted to Memorial Sloan Kettering Cancer Center (January 1, 2007–December 31, 2024) who developed Stage 3 AKIN AKI and were initiated on RRT. Patients with ESRD were excluded. Outcomes were stratified as: in-hospital death, post-discharge death, and survival to last follow-up.
Results
Of 248 patients (mean age 63 years; 61% male), 141 (56.9%) died during the index hospitalization, 89 (35.9%) died post-discharge, and 18 (7.3%) survived, yielding overall mortality of 92.7%. Sepsis was the dominant predictor of in-hospital death, occurring in 85.8% of in-hospital decedents versus 33.3% of survivors (p<0.001). ICU admission was near-universal (89.5%), occurring in 97.9% of in-hospital decedents versus 72.2% of survivors (p<0.001). Survivors had longer hospital stays (38.4 vs 19.3 days; p=0.009), consistent with prolonged illness followed by recovery. Mean time to RRT initiation was 8.66 days; survivors initiated RRT earlier (6 days) versus in-hospital decedents (9 days). In-hospital mortality differed by modality: 78.1% (CRRT), 54.0% (CRRT+IHD), and 27.1% (IHD). Cumulative mortality was 60.5% at 30 days, 67.7% at 90 days, and 79.0% at one year.
Conclusion
In this 17-year cohort, RRT was associated with 92.7% overall mortality and 60.5% 30-day mortality. Sepsis and CRRT requirement were the strongest predictors of in-hospital death. These findings challenge routine RRT escalation in metastatic cancer patients with AKI and highlight the need for structured goals-of-care discussions grounded in realistic prognosis.
Key Outcomes by Patient Group
| All Patients (N=248) | In-Hospital Deaths (n=141) | Survivors (n=18) | Post Discharge Deaths (n=89) | p value | |
| Overall mortality, n (%) | 230 (92.7%) | ||||
| Sepsis, n (%) | 169 (68.1%) | 121 (85.8%) | 6 (33.3%) | 39 (43.8%) | <0.001 |
| ICU admission, n (%) | 222 (89.5%) | 138 (97.9%) | 13 (72.2%) | 69 (77.5%) | <0.001 |
| Hospital LOS, mean days | 25.4 (23.6) | 19.3 (15.7) | 38.4 (31.9) | 31.3 (29.3) | 0.009 |