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Observational Study
. 2018 Mar 1;36(7):682-688.
doi: 10.1200/JCO.2017.75.7161. Epub 2018 Jan 10.

Development and Validation of a Risk Prediction Model for Acute Kidney Injury After the First Course of Cisplatin

Shveta S Motwani  1 , Gearoid M McMahon  1 , Benjamin D Humphreys  1 , Ann H Partridge  1 , Sushrut S Waikar  1 , Gary C Curhan  1
Affiliations
Observational Study

Development and Validation of a Risk Prediction Model for Acute Kidney Injury After the First Course of Cisplatin

Shveta S Motwani et al. J Clin Oncol. .

Abstract

Purpose Cisplatin-associated acute kidney injury (C-AKI) is common. We sought to develop and validate a predictive model for C-AKI after the first course of cisplatin. Methods Clinical and demographic data were collected on patients who received cisplatin between 2000 and 2016 at two cancer centers. C-AKI was defined as a 0.3 mg/dL rise in serum creatinine within 14 days of receiving cisplatin. Using multivariable logistic regression models with C-AKI as the primary outcome, we created a scoring model from the development cohort (DC) and tested it in the validation cohort (VC). Results C-AKI occurred in 13.6% of 2,118 patients in the DC and in 11.6% of 2,363 patients in the VC. Factors significantly associated with C-AKI included age 61 to 70 years (odds ratio [OR], 1.64 [95% CI, 1.21 to 2.23]; P = .001) and 71 to 90 years (OR, 2.97 [95% CI, 2.06 to 4.28]; P < .001) compared with ≤ 60 years; cisplatin dose 101 to 150 mg (OR, 1.58 [95% CI, 1.14 to 2.19]; P = .007) and > 150 mg (OR, 3.73 [95% CI, 2.68 to 5.20]; P < .001) compared with ≤ 100 mg; a history of hypertension (OR, 2.10 [95% CI, 1.54 to 2.72]; P < .001) compared with no hypertension; and serum albumin 2.0 to 3.5 g/dL (OR, 2.21 [95% CI, 1.62 to 3.03]; P < .001) compared with > 3.5 g/dL. The baseline estimated glomerular filtration rate was not significantly associated with the risk of C-AKI. The c-statistics of the score-based model in the DC and the VC were 0.72 (95% CI, 0.69 to 0.75) and 0.70 (95% CI, 0.67 to 0.73), respectively. Scores of 0, 3.5, and 8.5 were associated with a probability of C-AKI of 0.03 (95% CI, 0.03 to 0.05), 0.12 (95% CI, 0.11 to 0.14), and 0.51 (95% CI, 0.43 to 0.60), respectively. Conclusion A score-based model created by using the patient's age, cisplatin dose, hypertension, and serum albumin is predictive of C-AKI.

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Figures

Fig 1.
Fig 1.
(A) Development cohort. (B) Validation cohort.
Fig 2.
Fig 2.
Frequency of cisplatin-associated acute kidney injury (C-AKI) in the development and validation cohorts across score ranges.
Fig 3.
Fig 3.
Predicted probability of cisplatin-associated acute kidney injury (C-AKI) across scores, with 95% CIs.
See this image and copyright information in PMC

Comment in

  • Risk Prediction Model for Cisplatin-Associated Acute Kidney Injury.
    Kurokawa T, Tsurita G, Tanimoto T, Yamada T, Ferrone S. Kurokawa T, et al. J Clin Oncol. 2018 Aug 10;36(23):2453-2454. doi: 10.1200/JCO.2018.77.8761. Epub 2018 Jun 29. J Clin Oncol. 2018. PMID: 29958036 No abstract available.
  • Reply to T. Kurokawa et al.
    Motwani SS, Curhan GC. Motwani SS, et al. J Clin Oncol. 2018 Aug 10;36(23):2454. doi: 10.1200/JCO.2018.79.0832. Epub 2018 Jun 29. J Clin Oncol. 2018. PMID: 29958038 No abstract available.

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