Download Acute kidney injury in cancer patients

Acute kidney injury in cancer
patients
Wim Van Biesen
for
Norbert Lameire
Em prof of Medicine
University Hospital
Gent, Belgium
Tbilisi, october 2015
Cumulative incidence (risk) of AKI during the
first 5 years after a cancer diagnosis
37,267 incident
cancer patients
-5yrs FU
mortality
9613 (25.8%)
developed AKI
R
I
F
1-yr risk:17.5%
5-yr risk: 27.0%
Christiansen et al. / European J Int Med 22 (2011) 399–406
The timing of AKI, presented as percentages of
total AKI against days after admission to the
cancer center.
* 12% of all admissions to cancer center
over 3 month period had AKI
* Most cases seen in recent admissions
Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013.
Main associated factors of AKI in cancer patients(n:
309)
Soares et al, J Clin Oncol 24:4003-4010, 2006
Kaplan-Meyer survival curve for 90 days after admission to
the cancer center based on AKI severity by RIFLE
Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013
Length of
hospital stay
Hospital bills
Salahudeen et al,
Clin J Am Soc Nephrol
Large confidence intervals
Length of
hospital stay
Hospital bills
Salahudeen et al,
Clin J Am Soc Nephrol
Effect of AKI on outcomes of cancer
patients
Campbell et al, Adv CKD, 2014, 21: 64-71
Anticancer therapies requiring dosage
adjustment as a percentage of prescriptions
(A) and as a percentage of treated patients (B).
Launay-Vacher et al, Cancer 2007;110:1376–1384.
S crea = 1.5: what about renal function???
Patient-specific factors that increase risk for
chemotherapy- asssociated nephrotoxicity
Shirali, Perazella, Adv CKD , 2014, 21: 56-63,
Categories of
chemotherapyInduced nephrotoxicity
Perazella, Moeckel, Semin Nephrol
Pathophysiology of cisplatinum nephrotoxicity
Pabla N, Dong Z. Kidney Int 73: 994–1007, 2008.
Magnesium supplementation in
prevention of cisplatinum nephrotoxicity
Kidera et al, PLoS ONE 9(7): e101902., 2014
Comparison of cis-platin with its Second and Third
Generation Platinum Analogues
Purine metabolism-
uric acid is the endproduct in humans
Wilson, Berns Adv CKD, 2014, 21: 18-26
The Cairo-Bishop Definitions of laboratory and
clinical Tumor Lysis Syndrome
Wilson, Berns Adv CKD, 2014, 21: 18-26
Reported incidences of TLS stratified by Risk
Category
Flowchart of patients included in the
study according to the presence of TLS
Darmon et al, British Journal of Haematology, 2013, 162, 489–497
Prophylaxis and Treatment of Tumor Lysis Syndrome
Denker et al, European J Int Med 22 (2011) 348–354
Only 1 RCT
7 observational historical control
Risk of AKI associated with androgen
deprivation therapy for advanced prostate
cancer (observational)
Lapi et al , JAMA. 2013;310(3):289-296.
Cumulative incidence plot depicting the rates of AKI after
stratifying patients according to the type of androgen
deprivation for non metastatic prostate Ca
(gonadotropin releasing agonists)
Gandaglia et al, EUROPEAN UROLOGY 66 (2014) 1125–1132
Mechanisms of FLCs-induced kidney injury
Davenport, Merlini, Nephrol Dial Transplant (2012) 27: 3713–3718
Probability of renal recovery following sustained
reduction in free light chain levels at day 21 in myeloma
kidney.
Hutchison et al. J. Am. Soc. Nephrol. 22, 1129–1136 © 2011
Combination of bortezomib-based chemotherapy
and extracorporeal free light chain removal for
treating cast nephropathy in MM-2 cases
Bachmann et al, NDT Plus (2008) 2: 106–108
Figure 2. Forest plot of weighted risk ratio comparing 6-month survival rate between chemotherapy with
plasmapheresis and chemotherapy only group.
Figure 3. Forest plot of weighted risk ratio comparing 6-month dialysis-dependent rate between
chemotherapy with plasmapheresis and chemotherapy only group.
Novel approaches for reducing free
light chains in patients with myeloma
kidney
Hutchison, C. A. et al. Nat. Rev. Nephrol. 8, 234–243 (2012 )
General conclusions
• Be aware of renal probems in patients with cancer
• Acute Kidney Injury
• Chronic Kidney injury
• Keep it simple:
• rehydration
• dose-adaptation
• most “exciting new promising” therapies NOT
supported by evidence