“Nearly 1 in 10 patients initiating systemic cancer therapy will experience a hospitalization or receive acute dialysis for acute kidney injury…” “This magnitude of acute kidney injury risk may be underappreciated by both clinicians and patients commencing systemic cancer treatment, given the paucity of existing data.”

Median follow-up was 1.85 years (interquartile range, 0.77-3.83). A total of 10,880 patients in the cohort experienced acute kidney injury over 403,530 patient-years of follow-up.

Researchers observed an AKI rate of 27 per 1,000 person-years and an overall cumulative incidence rate of 9.3%  Annual incidence of acute kidney injury nearly tripled during the study period, from 18 to 52 events per 1,000 person-years (P for trend = < .001).

Cancers with the highest 5-year cumulative incidence of AKI were myeloma, bladder cancer and leukemia.

Cancers with the highest HRs for AKI — after adjustment for possible cofounders and relative to breast cancer, which was the referent because it was the most common cancer among the cohort — included multiple myeloma (adjusted HR [aHR] = 4.3; 95% CI, 3.83-4.82), bladder cancer (aHR = 3.69; 95% CI, 3.28-4.16) and cervical cancer (aHR = 3.47, 95% CI, 2.9-4.14).

Patients with myeloma who received a bortezomib-based treatment regimen had a decreased risk for AKI, according to researchers…

Patients aged 66 years or older appeared at higher risk for AKI if they took a prescribed diuretic or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker . Researchers said holding or discontinuing the medications at the time of systemic therapy initiation could decrease the risk for injury…

Limitations of this study included a lack of serum creatinine data and a lack of data surrounding acute kidney injury among patients who were not hospitalized, which could have led to an underestimation of the overall incidence of injury.

“Considerable advances in the treatment of many cancer types have been made in the last decade, including in multiple myeloma and kidney cancers,” Kitchlu and colleagues wrote. “As such, a reassessment of [acute kidney injury] incidence across various cancer types in the current era of cancer treatment is warranted.” – by John DeRosier

Disclosures: This study was funded by the Institute for Clinical Evaluative Sciences. All study authors report no relevant financial disclosures.

Innovative Strategies to Combat Kidney Disease

“High blood pressure, elevated blood sugar¸ NSAIDs (such as ibuprofen), certain medications, and high-protein diets are the most common threats to kidney health. The potentially lethal insults they inflict include oxidative stress, production of advanced glycation and lipoxidation end products (AGEs and ALEs), inflammation, and an excessive filtration burden that taxes renal function over time.

Nutrients such as pyridoxal-5-phosphate (P5P) fight AGEs and ALEs. CoQ10, silymarin, resveratrol, and lipoic acid are also clinically supported, potent interventions. Omega-3 fatty acids help quell inflammation, contributing to enhanced kidney health. A host of additional nutrients complement these actions, including folic acid (folate) and vitamins C and E.”