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. 2022 May 24:12:627895.
doi: 10.3389/fonc.2022.627895. eCollection 2022.

Acute Kidney Injury in Adult Patients With Hepatocellular Carcinoma After TACE or Hepatectomy Treatment

Zhixiang Mou  1 , Tianjun Guan  1 , Lan Chen  1
Affiliations

Acute Kidney Injury in Adult Patients With Hepatocellular Carcinoma After TACE or Hepatectomy Treatment

Zhixiang Mou et al. Front Oncol. .

Abstract

Background: Acute kidney injury (AKI) is one of the most common complications in patients with cancer, yet the specific reasons, mechanisms, and the influence of AKI are not clear in hepatocellular carcinoma (HCC) after treatment. This meta-analysis aimed to find out the risk factors and the impact on mortality of AKI in adult patients with HCC after treatment using available published data.

Methods: We performed a systemic literature search using PubMed, Web of Science, and Embase, encompassing publications up until November 30, 2021 (inclusive), with 17 cohort studies involving 11,865 patients that fulfilled the prespecified criteria for inclusion in the meta-analysis. The number of AKI/non-AKI patients identified by risk factors, the number of AKI/non-AKI-related deaths, the incidence rates, the mortality rates, and the irreversible rates of AKI were derived and analyzed using STATA.

Results: Age, diabetes mellitus (DM), and the number of transarterial chemoembolization (TACE) sessions are risk factors for AKI in patients with HCC after TACE. On the other hand, male gender, age, DM, major resection of the liver, and operation-related transfusion are risk factors for AKI in patients with HCC after hepatectomy. The risk of mortality in those with renal failure due to AKI was up to 4.74 times higher than in those without AKI in a short-term observation period after TACE treatment.

Conclusions: Attention should be paid to the risk of AKI in HCC patients with DM. The occurrence of AKI during TACE treatment is especially dangerous and should be considered a strong red flag, obviously with regard to the extremely high risk of death in a short period. Furthermore, studies are needed to detect more associations of AKI in patients with HCC.

Keywords: AKI; HCC; hepatocellular carcinoma; mortality; risk.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for this meta-analysis.
Figure 2
Figure 2
Forest plots of the included studies assessing the risk factors for AKI in patients with HCC who received TACE treatment. The solid vertical line indicates no effect. The horizontal lines represent the 95% confidence intervals (CIs). (A) Incidence rates of AKI in these patients. (B–I) Supposing male gender (B), multiple tumor (C), DM (D), HBsAg(+) (E), the number of TACE sessions (F), amount of contrast (G), NSAID use (H), and age (I) as risk factors. AKI, acute kidney injury; HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; DM, diabetes mellitus; NSAID, nonsteroidal anti-inflammatory drug.
Figure 3
Figure 3
Forest plots of the included studies assessing the risk of acute kidney injury (AKI) in patients with hepatocellular carcinoma (HCC) who received transarterial chemoembolization (TACE) treatment. The solid vertical line indicates no effect. The horizontal lines represent the 95% confidence intervals (CIs). (A) Mortality rates of AKI in these patients. (B) Mortality risk with AKI during the short term. (C) Irreversible rates of AKI in these patients. (D) Mortality risk with AKI after long-term observation.
Figure 4
Figure 4
Forest plots of the included studies assessing the risk factors for acute kidney injury (AKI) in patients with hepatocellular carcinoma (HCC) after hepatectomy. The solid vertical line indicates no effect. The horizontal lines represent the 95% confidence intervals (CIs). (A) Incidence rates of AKI in these patients. (B–F) Supposing male gender (B), diabetes mellitus (DM) (C), major resection of the liver (D), receiving transfusion (E), and age (F) as risk factors.
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