Dataset Information

Acute kidney injury predicts all-cause mortality in patients with cancer.

ABSTRACT:

Background

Acute kidney injury (AKI) is a critical issue in cancer patients because it is not only a morbid complication but also able to interrupt timely diagnostic evaluation or planned optimal treatment. However, the impact of AKI on overall mortality in cancer patients remains unclear.

Methods

We conducted a retrospective cohort study of 67 986 cancer patients, from 2004 to 2013 to evaluate the relationship between AKI and all-cause mortality. We used KDIGO AKI definition and grading system.

Results

During 3.9 ± 3.1 years of follow-up, 33.8% of the patients experienced AKI at least once. Among AKI events, stage 1, 2, and 3 was 71.0%, 13.8%, and 15.1%, respectively. AKI incidence was highest in hematologic malignancies, followed by urinary tract cancer, and hepatocellular carcinoma. Male sex, older age, underlying diabetes and hypertension, lower serum albumin and plasma hemoglobin, more frequent radio-contrast exposure, entrance of clinical trials, and receiving chemotherapy were associated with AKI occurrence. AKI development was an independent risk factor for elevated mortality in cancer patients with dose-responsive manner (Stage 1, hazard ratio [HR] 1.183, 95% confidence interval [CI] 1.145-1.221, P < 0.001; Stage 2, HR 1.710, 95% CI 1.629-1.796; Stage 3, HR 2.000, 95% CI 1.910-2.095; No AKI, reference group) even after adjustment. This tendency was reproduced in various cancer types except thyroid cancer and in various treatment modalities, however, not shown in patients with baseline renal dysfunction.

Conclusion

AKI was an independent risk factor for all-cause mortality in overall cancer patients with dose-responsive manner.

SUBMITTER: Kang E

PROVIDER: S-EPMC6558474 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Publications

Acute kidney injury predicts all-cause mortality in patients with cancer.

Kang Eunjeong E Park Minsu M Park Peong Gang PG Park Namyong N Jung Younglee Y Kang U U Kang Hee Gyung HG Kim Dong Ki DK Oh Kook-Hwan KH Joo Kwon Wook KW Kim Yon Su YS Yoon Hyung-Jin HJ Lee Hajeong H

Cancer medicine 20190409 6

<h4>Background</h4>Acute kidney injury (AKI) is a critical issue in cancer patients because it is not only a morbid complication but also able to interrupt timely diagnostic evaluation or planned optimal treatment. However, the impact of AKI on overall mortality in cancer patients remains unclear.<h4>Methods</h4>We conducted a retrospective cohort study of 67 986 cancer patients, from 2004 to 2013 to evaluate the relationship between AKI and all-cause mortality. We used KDIGO AKI definition and ...[more]

PMID: 30968593

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Project description:Acute kidney injury is a frequent complication of cardiac surgery and increases morbidity and mortality. As preoperative biomarkers predicting the development of acute kidney injury are not available, we have tested the hypothesis that preoperative plasma levels of endogenous ouabain may function as this type of biomarker.Endogenous ouabain is an adrenal stress hormone associated with adverse cardiovascular outcomes. Its involvement in acute kidney injury is unknown. With studies in patients and animal settings, including isolated podocytes, we tested the above mentioned hypothesis.Preoperative endogenous ouabain was measured in 407 patients admitted for elective cardiac surgery and in a validation population of 219 other patients. We also studied the effect of prolonged elevations of circulating exogenous ouabain on renal parameters in rats and the influence of ouabain on podocyte proteins both "in vivo" and "in vitro."In the first group of patients, acute kidney injury (2.8%, 8.3%, 20.3%, p < 0.001) and ICU stay (1.4±0.38, 1.7±0.41, 2.4±0.59 days, p = 0.014) increased with each incremental preoperative endogenous ouabain tertile. In a linear regression analysis, the circulating endogenous ouabain value before surgery was the strongest predictor of acute kidney injury. In the validation cohort, acute kidney injury (0%, 5.9%, 8.2%, p < 0.0001) and ICU stay (1.2±0.09, 1.4±0.23, 2.2±0.77 days, p = 0.003) increased with the preoperative endogenous ouabain tertile. Values for preoperative endogenous ouabain significantly improved (area under curve: 0.85) risk prediction over the clinical score alone as measured by integrate discrimination improvement and net reclassification improvement. Finally, in the rat model, elevated circulating ouabain reduced creatinine clearance (-18%, p < 0.05), increased urinary protein excretion (+ 54%, p < 0.05), and reduced expression of podocyte nephrin (-29%, p < 0.01). This last finding was replicated ex vivo by incubating podocyte primary cell cultures with low-dose ouabain.Preoperative plasma endogenous ouabain levels are powerful biomarkers of acute kidney injury and postoperative complications and may be a direct cause of podocyte damage.

Dataset Information

Acute kidney injury predicts all-cause mortality in patients with cancer.

Background

Methods

Results

Conclusion

Publications

Acute kidney injury predicts all-cause mortality in patients with cancer.

Similar Datasets

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