Pharmacological nephrotoxicity profile in a comprehensive cancer center: What changed in two decades and predictors for the need for haemodialysis and mortality

Abstract

Introduction and objectives: Acute kidney injury (AKI) is a frequent and severe complication in hospitalised cancer patients. However, overall data from in-hospital drug-related AKI in cancer patients is scarce. We aim to review the profile of moderate to severe drug-induced AKI in patients admitted to an oncology hospital over the last two decades and to assess renal and overall outcomes.

Material and methods: 410 cases of drug-induced AKI KDIGO≥2 were analyzed, comparing between two decades from 2002 to 2021 in a comprehensive cancer center.

Results: The main differences were the introduction of new classes of cancer therapy (e.g., immune checkpoint inhibitors [ICPI] and tyrosine kinase inhibitors [TKI]), a decrease in nephrotoxicity due to platinum-based drugs, and an increase in nephrotoxicity caused by multiple drugs without cancer-directed therapy. Mortality was similar, but the need for haemodialysis (HD) was higher in the second decade (25.5% vs 36.6%, p=0.02). Multivariate analysis presented invasive mechanical ventilation and sepsis as risk factors for both HD and mortality, haematologic cancer as risk factors for HD, and the need for HD and multiple drugs without cancer-directed therapy as risk factors for mortality.

Conclusion: Adequate drug surveillance and prophylaxis render cancer therapy as a relatively small contributor to drug-induced AKI in a comprehensive cancer center. Critically ill patients have a higher need for HD and mortality regardless of the nephrotoxic agent implied.

Keywords: Acute kidney injury; Cancer patients; Drug nephrotoxicity; Haemodialysis; Hemodiálisis; Lesión renal aguda; Mortalidad; Mortality; Nefrotoxicidad inducida por fármacos; Onco-nephrology; Onconefrología; Pacientes con cáncer.