Kitchlu A, et al. - Researchers determined acute kidney injury (AKI) incidence and risk factors in patients receiving systemic treatment for cancer, given this patient population has an increased risk of AKI. Findings revealed a common incidence of cancer-related AKI. Associations of cancer-related AKI with advanced stage, chronic kidney disease, diabetes, and concomitant receipt of diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, were seen. A heightened risk was observed in the 90 days after systemic therapy. In this population, there is a need of preventive strategies to address the increasing burden of AKI.

Methods

• Researchers performed this population-based study of all patients initiating systemic therapy (chemotherapy or targeted agents) for a new cancer diagnosis in Ontario, Canada (2007–2014).
• Hospitalization with AKI or acute dialysis was assessed as primary outcome.
• They estimated the cumulative incidence of AKI.
• They also fitted Fine and Gray models, adjusting for demographics, cancer characteristics, comorbidities, and coprescriptions.
• As a time-varying covariate, they modeled exposure to systemic therapy (the 90-day period following treatments).
• Temporal trends in annual AKI incidence were also evaluated.

Results

• A total of 163,071 patients initiating systemic therapy were identified.
• Among these, AKI occurred in 10,880.
• The estimated rate of AKI was 27 per 1000 person-years, with overall cumulative incidence of 9.3% (95% CI = 9.1% to 9.6%).
• Myeloma (26.0%, 95% CI = 24.4% to 27.7%), bladder (19.0%, 95% CI = 17.6% to 20.5%), and leukemia (15.4%, 95% CI = 14.3% to 16.5%) comprised the malignancies with the highest 5-year AKI incidence.
• An increased risk of AKI was noted in relation to advanced cancer stage, chronic kidney disease, and diabetes (adjusted hazard ratios [aHR] = 1.41, 95% CI = 1.28 to 1.54; 1.80, 95% CI = 1.67 to 1.93; and 1.43, 95% CI = 1.37 to 1.50, respectively).
• A higher AKI risk was observed in relation to diuretic, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker coprescription in patients aged 66 years or older with universal drug benefits (aHR = 1.20, 95% CI = 1.14 to 1.28; 1.30, 95% CI = 1.23 to 1.38).
• During the 90-day period following systemic therapy, a further accentuation of AKI risk was noted (aHR = 2.34, 95% CI = 2.24 to 2.45).
• Between 2007 and 2014, increase in the annual incidence of AKI was noted, from 18 to 52 per 1000 person-years.