Incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a comprehensive cancer center

Abstract

Background and objectives: Incidence of AKI in hospitalized patients with cancer is increasing, but reports are scant. The objective of this study was to determine incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a cancer center.

Design, setting, participants, & measurements: Cross-sectional analysis of prospectively collected data on 3558 patients admitted to the University of Texas M.D. Anderson Cancer Center over 3 months in 2006.

Results: Using modified RIFLE (Risk, Injury, Failure, Loss, ESRD) criteria, 12% of patients admitted to the hospital had AKI, with severity in the Risk, Injury, and Failure categories of 68%, 21%, and 11%, respectively. AKI occurred in 45% of patients during the first 2 days and in 55% thereafter. Dialysis was required in 4% of patients and nephrology consultation in 10%. In the multivariate model, the odds ratio (OR) for developing AKI was significantly higher for diabetes (OR, 1.89; 95% confidence interval [CI], 1.51-2.36), chemotherapy (OR, 1.61; 95% CI, 1.26-2.05), intravenous contrast (OR, 4.55; 95% CI, 3.51-5.89), hyponatremia (OR, 1.97; 95% CI, 1.57-2.47), and antibiotics (OR, 1.52; 95% CI, 1.15-2.02). In patients with AKI, length of stay (100%), cost (106%), and odds for mortality (4.7-fold) were significantly greater.

Conclusion: The rate of AKI in patients admitted to a comprehensive cancer center was higher than the rate in most noncancer settings; was correlated significantly with diabetes, hyponatremia, intravenous contrast, chemotherapy, and antibiotics; and was associated with poorer clinical outcomes. AKI developed in many patients after admission. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.

Figure 1.

Flowchart displaying the chart evaluation process for all patients admitted to the cancer center during a 3-month period.

Figure 2.

The timing of AKI, presented as percentages of total AKI against days after admission to the cancer center.

Figure 3.

Box plots of lengths of hospital stay (top panel) and hospital bills (bottom panel) in patients hospitalized in the cancer center with and without AKI. Central lines denote median values, and upper and lower borders represent 25th and 75th percentiles. The whiskers represent the highest and lowest values. Extreme values and outliers are not shown. *P<0.001 for AKI versus non-AKI for both plots.

Figure 4.

Kaplan-Meyer survival curve for 90 days after admission to the cancer center based on AKI severity by RIFLE (Risk, Injury, Failure, Loss, ESRD) criteria.