Understanding the Risk Factors and Long-Term Consequences of Cisplatin-Associated Acute Kidney Injury: An Observational Cohort StudyReport as inadecuate




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Acute kidney injury AKI is a well-known complication of cisplatin-based chemotherapy; however, its impact on long-term patient survival is unclear. We sought to determine the incidence and risk factors for development of cisplatin-associated AKI and its impact on long-term renal function and patient survival. We identified 233 patients who received 629 cycles of high-dose cisplatin 99±9mg-m2 for treatment of head and neck cancer between 2005 and 2011. These subjects were reviewed for development of AKI. Cisplatin nephrotoxicity CN was defined as persistent rise in serum creatinine, with a concomitant decline in serum magnesium and potassium, in absence of use of nephrotoxic agents and not reversed with hydration. All patients were hydrated per protocol and none had baseline glomerular filtration rate GFR via CKD-EPI<60mL-min-1.73m2. The patients were grouped based on development of AKI and were staged for levels of injury, per KDIGO-AKI definition. Renal function was assessed via serum creatinine and estimated glomerular filtration rate eGFR via CKD-EPI at baseline, 6- and 12-months. Patients with AKI were screened for the absence of nephrotoxic medication use and a temporal decline in serum potassium and magnesium levels. Logistic regression models were constructed to determine risk factors for cisplatin-associated AKI. Twelve-month renal function was compared among groups using ANOVA. Kaplan-Maier curves and Cox proportional hazard models were constructed to study its impact on patient survival. Of 233 patients, 15868% developed AKI; 77 49% developed stage I, 55 35% developed stage II, and 26 16% developed stage III AKI. Their serum potassium and magnesium levels correlated negatively with level of injury p<0.05. African American race was a significant risk factor for cisplatin-associated AKI, OR 2.8 95% CI 1.3 to 6.3 and 2.8 95% CI 1.2 to 6.7 patients with stage III AKI had the lowest eGFR value at 12 months p = 0.05 and long-term patient survival HR 2.1; p<0.01 than patients with no or lower grades of AKI. Most common causes of death were recurrent cancer 44% or secondary malignancy elsewhere 40%. Cisplatin-associated severe AKI occurs in 20% of the patients and has a negative impact on long-term renal function and patient survival. PEG tube placement may be protective and should be considered in high risk-patients.



Author: Zeenat Yousuf Bhat , Pravit Cadnapaphornchai, Kevin Ginsburg, Milani Sivagnanam, Shamit Chopra, Corey K. Treadway, Ho-Sheng Lin,

Source: http://plos.srce.hr/



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