(006) Cancer treatment and the risk of acute kidney injury

Background: Acute kidney injury (AKI) is common in cancer patients. However, valid estimates of the risk and prognosis of AKI in relation to a broad spectrum of cancer treatments are lacking.

Objectives: To examine the risk of and mortality after AKI in relation to a wide range of specific cancer treatments including surgery, anticancer drugs, and hematopoietic stem cell transplantation (HSCT).

Methods: We conducted a nationwide population-based cohort study including patients receiving cancer treatments in Denmark from 2010 to 2022 and recording AKI episodes based on changes in plasma creatinine measured at Danish hospitals and in general practices. We calculated the risk of AKI within the first 7 days after surgery, within the first 365 days after initiation of anticancer drugs, and within the first 100 days after HSCT. We assessed the 1-year mortality in patients with AKI and in a comparison cohort including sex-, cancer type-, metastasis status-, and treatment-matched patients without AKI. Moreover, we compared the 1-year mortality of patients with AKI to that of patients without AKI by computing age- and comorbidity-adjusted hazard ratios using Cox proportional hazards regression.

Results: We identified 290,100 adult patients with cancer during the study period. The risk of AKI following cancer surgery ranged from 0.2% (orchiectomy in testis cancer) to 69.2% (nephrectomy in kidney cancer). The risk of AKI following initiation of anticancer drugs ranged from 3.3% (cyclophosphamide in breast cancer) to 78.3% (anticancer drugs in acute lymphatic leukemia). The risk of AKI after HSCT was high ranging from 20.2% (multiple myeloma) to 78.5% (leukemia). AKI was associated with an increased 1-year mortality and adjusted hazard ratio across most of the interventions (some with adjusted hazard ratios exceeding 10), exceptions to this included nephrectomy in kidney cancer and cystectomy in urinary bladder cancer.

Conclusions: The risk of AKI is high after a wide range of cancer treatments; moreover, AKI is associated with an increased mortality in most cancer treatments. Though we could not rule out the causal relationship in these associations, the findings highlight the importance of assessing kidney function following cancer treatments and that AKI is a prognostic marker for mortality.