Severe Acute Kidney Injury in Hospitalized Cancer Patients: Epidemiology and Predictive Model of Renal Replacement Therapy and In-Hospital Mortality

CANCERS(2024)

Cited 0|Views6
No score
Abstract
Simple Summary Acute kidney injury (AKI) is a common complication among hospitalized cancer patients, impacting the effectiveness of anticancer treatment and being associated with a poor prognosis. The identification of risk factors and the underlying cause(s) of AKI ensures appropriate intervention. Limited studies on this subject have been conducted to identify high-risk patients and guide decisions on the initiation of renal replacement therapy (RRT). Our study provides an overview of the causes of AKI and identifies prognostic determinants of the need for RRT and in-hospital mortality. It introduces an easily calculated risk score that combines acute risk factors to predict in-hospital mortality, potentially helping in clinical practice with the complex decision to initiate or forgo RRT.Abstract Background: Acute kidney injury (AKI) is a common complication among cancer patients, often leading to longer hospital stays, discontinuation of cancer treatment, and a poor prognosis. This study aims to provide insight into the incidence of severe AKI in this population and identify the risk factors associated with renal replacement therapy (RRT) and in-hospital mortality. Methods: This retrospective cohort study included 3201 patients with cancer and severe AKI admitted to a Comprehensive Cancer Center between January 1995 and July 2023. Severe AKI was defined according to the KDIGO guidelines as grade >= 2 AKI with nephrological in-hospital follow-up. Data were analyzed in two timelines: Period A (1995-2010) and Period B (2011-2023). Results: A total of 3201 patients (1% of all hospitalized cases) were included, with a mean age of 62.5 +/- 17.2 years. Solid tumors represented 75% of all neoplasms, showing an increasing tendency, while hematological cancer decreased. Obstructive AKI declined, whereas the incidence of sepsis-associated, prerenal, and drug-induced AKI increased. Overall, 20% of patients required RRT, and 26.4% died during hospitalization. A predictive model for RRT (AUC 0.833 [95% CI 0.817-0.848]) identified sepsis and hematological cancer as risk factors and prerenal and obstructive AKI as protective factors. A similar model for overall in-hospital mortality (AUC 0.731 [95% CI 0.71-0.752]) revealed invasive mechanical ventilation (IMV), sepsis, and RRT as risk factors and obstructive AKI as a protective factor. The model for hemato-oncological patients' mortality (AUC 0.832 [95% CI 0.803-0.861]) included IMV, sepsis, hematopoietic stem cell transplantation, and drug-induced AKI. Mortality risk point score models were derived from these analyses. Conclusions: This study addresses the demographic and clinical features of cancer patients with severe AKI. The development of predictive models for RRT and in-hospital mortality, along with risk point scores, may play a role in the management of this population.
More
Translated text
Key words
acute kidney injury,cancer,epidemiology,mortality,renal replacement therapy
AI Read Science
Must-Reading Tree
Example
Generate MRT to find the research sequence of this paper
Chat Paper
Summary is being generated by the instructions you defined