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

Author:

Calças Marques Roberto1ORCID,Reis Marina2ORCID,Pimenta Gonçalo3,Sala Inês4ORCID,Chuva Teresa5ORCID,Coelho Inês5ORCID,Ferreira Hugo5,Paiva Ana5,Costa José Maximino5ORCID

Affiliation:

1. Nephrology Department, Centro Hospitalar Universitário do Algarve, 8000 Faro, Portugal

2. Nephrology Department, Centro Hospitalar Universitário de Coimbra, 3004 Coimbra, Portugal

3. Nephrology Department, Centro Hospitalar de Lisboa Ocidental, 2790 Lisboa, Portugal

4. Nephrology Department, Centro Hospitalar Universitário de Santo António, 4050 Porto, Portugal

5. Nephrology Department, Instituto Português de Oncologia do Porto, 4200 Porto, Portugal

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.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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