Impact of developing dialysis-requiring acute kidney injury on long-term mortality in cancer patients with septic shock

Abstract

Abstract Considering recent advances in both cancer and sepsis management, we were to evaluate the associated factors for occurrence of septic acute kidney injury (AKI) in cancer patients using a nationwide population-based cohort data. Using data from the National Health Insurance Service of Korea, adult cancer patients who presented to emergency department with septic shock from 2009 to 2017 were analyzed. Cox-proportional hazard model was conducted to evaluate the clinical effect of sepsis-related AKI requiring dialysis. Among 42,477 adult cancer patients with septic shock (90% solid and 10% hematologic cancer cases), dialysis-requiring AKI occurred in 5,449 (12.8%). Recovery from dialysis within 30-day was 77.9% and overall, 30-day and 2-year mortality rates were 52.1% and 85.1%, respectively. Oncologic patients with dialysis-requiring AKI were frequently occurred in male, history of hypertension, diabetes, congestive heart failure, liver cirrhosis, and patients with hematologic cancer. In multivariate Cox-proportional hazard model showed that dialysis-requiring acute kidney injury had the highest adjusted hazard ratio of 1.353 (95% confidence interval 1.313–1.395) for 2-year mortality. Dialysis-requiring septic AKI is not occurred commonly (about 13%). However, it had a significant association with the increased long-term mortality which emphasis on the prevention of AKI particularly in male hematologic cancer patients.