DENVER– Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.
Dr. Abdulla K. Salahudeen
While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, "there is very little literature available about what happens to cancer patients admitted to the hospital," lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients."
In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.
Complete information was available on 5,013 of the 5,491 patients, reported Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas M.D. Anderson Cancer Center, Houston. The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.
On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).
On multivariate logistic regression, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).
Multivariate regression analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.
"It is possible that what we are seeing is an association between severity of cancer and level of kidney injury," said Dr. Salahudeen, who emphasized the preliminary nature of the study. "This is a complex group of patients, and the study underscores the importance of being aggressive with treatment of acute kidney injury as early as possible. The question is, if we were to screen these people as they come into the hospital, can we identify those who are at risk? That’s where acute kidney injury biomarkers are going to come in useful."
Dr. Salahudeen said that he had no relevant financial conflicts to disclose.