Department of Medicine, Division of Nephrology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Nephrol Dial Transplant. 2022 Feb 25;37(3):507-514. doi: 10.1093/ndt/gfaa372.
Our objective was to characterize the incidence, risk factors and clinical features of acute kidney injury (AKI) in patients receiving dabrafenib and trametinib.
We performed a retrospective cohort study examining the kidney outcomes of patients in a large healthcare system who received dabrafenib/trametinib between 2010 and 2019. The primary outcome was AKI, defined as a 1.5-fold increase in serum creatinine from baseline within a 12-month study period. AKI severity and etiology was determined for each case by chart review. Logistic regression was used to evaluate baseline predictors of AKI.
A total of 199 patients who received dabrafenib in our healthcare system from 2010 to 2019 were included in the analysis. Forty-two patients (21%) experienced AKI within 12 months; 10 patients (5% of the total cohort, 24% of AKI patients) experienced AKI occurring during a dabrafenib/trametinib-induced febrile syndrome characterized by fever, chills, gastrointestinal symptoms and elevated liver enzymes. Preexisting liver disease was the only significant predictor of AKI in the cohort. One patient had biopsy-proven granulomatous acute interstitial nephritis that resolved with corticosteroids.
Oncologists and nephrologists should be aware that AKI is common after dabrafenib/trametinib and a substantial number of cases occur in the setting of treatment-induced pyrexia.
我们的目的是描述接受达拉非尼和曲美替尼治疗的患者发生急性肾损伤（AKI）的发病率、风险因素和临床特征。
我们进行了一项回顾性队列研究，研究了在 2010 年至 2019 年期间接受达拉非尼/曲美替尼治疗的大型医疗保健系统患者的肾脏结局。主要结局是 AKI，定义为在 12 个月的研究期内血清肌酐从基线水平升高 1.5 倍。通过病历回顾确定每个病例的 AKI 严重程度和病因。使用逻辑回归评估 AKI 的基线预测因素。
在我们的医疗保健系统中，共有 199 名患者在 2010 年至 2019 年期间接受了达拉非尼治疗，他们被纳入了分析。在 12 个月内，42 名患者（21%）发生 AKI；10 名患者（总队列的 5%，AKI 患者的 24%）发生 AKI，伴有发热、寒战、胃肠道症状和肝酶升高的达拉非尼/曲美替尼诱导的发热综合征。存在先前的肝脏疾病是队列中 AKI 的唯一显著预测因素。1 名患者发生活检证实的肉芽肿性急性间质性肾炎，用皮质类固醇治疗后缓解。
肿瘤学家和肾病学家应该意识到，达拉非尼/曲美替尼治疗后 AKI 很常见，并且相当多的病例发生在治疗诱导发热的情况下。
