Renal Division, Department of Medicine, Peking University First Hospital, and Institute of Nephrology, Peking University, Beijing, People's Republic of China.
Department of Pharmacy, Peking University First Hospital, Beijing, China.
Eur J Clin Pharmacol. 2021 Oct;77(10):1503-1512. doi: 10.1007/s00228-021-03115-y. Epub 2021 May 15.
This study aims to detail the characteristics of chemotherapy-related acute kidney injury (CR-AKI) and investigate its effect on patient outcomes.
This is a multicenter cross-sectional study of cancer patients with CR-AKI screened from hospital-acquired adult AKI patients based on a nationwide AKI survey in China.
Of the 3468 patients with hospital-acquired AKI, 258 cases of CR-AKI were identified. Of the patients, 20.1% (52/258) were ≥ 70 years old. Among the 258 CR-AKI cases, 61 (23.6%) reached AKI stage 3, and 75 (29.1%) reached AKI stage 2. The remaining 122 (47.3%) remained at AKI stage 1. A total of 413 chemotherapeutic agents were related to AKI, of which platinum compounds (24.5%, 101/413) were the most common. In-hospital mortality was 14.7% (38/258), and the rate of AKI non-recovery was 48.3% (100/207). AKI stage 3 (OR 2.930, 95% CI 1.156-7.427) and age ≥ 70 years (OR 3.138, 95% CI 1.309-7.519) were independent risk factors for in-hospital death. Compared to stage 2 or 3 AKI cases, a higher proportion of patients with stage 1 AKI did not recover their renal function (57.1% vs. 41.4% vs. 36.4%, P = 0.032). More AKI episodes were not recognized in patients with stage 1 AKI compared with the other two groups (82.8% vs. 60.0% vs. 36.1%, P < 0.001).
CR-AKI accounted for a noteworthy proportion of hospital-acquired AKI, and severe CR-AKI increased in-hospital mortality. Mild CR-AKI was more likely to be overlooked, and sustained kidney injury was common in this situation. Recognizing CR-AKI at an early stage and personalizing treatment should be emphasized in those undergoing chemotherapy.
本研究旨在详细描述化疗相关性急性肾损伤（CR-AKI）的特征，并探讨其对患者结局的影响。
这是一项在中国全国性 AKI 调查的基础上，对筛选出的医院获得性 AKI 成年患者中的 CR-AKI 患者进行的多中心横断面研究。
在 3468 例医院获得性 AKI 患者中，发现 258 例 CR-AKI。患者中≥70 岁者占 20.1%（52/258）。258 例 CR-AKI 中，61 例（23.6%）达到 AKI 3 期，75 例（29.1%）达到 AKI 2 期。其余 122 例（47.3%）仍处于 AKI 1 期。共涉及 413 种化疗药物与 AKI 相关，其中铂类化合物（24.5%，101/413）最常见。住院病死率为 14.7%（38/258），AKI 未恢复率为 48.3%（100/207）。AKI 3 期（OR 2.930，95%CI 1.156-7.427）和≥70 岁（OR 3.138，95%CI 1.309-7.519）是住院死亡的独立危险因素。与 AKI 2 期或 3 期相比，AKI 1 期患者肾功能未恢复的比例更高（57.1%比 41.4%比 36.4%，P=0.032）。与其他两组相比，AKI 1 期患者更易漏诊 AKI 发作（82.8%比 60.0%比 36.1%，P<0.001）。
CR-AKI 在医院获得性 AKI 中占相当大的比例，严重的 CR-AKI 增加了住院死亡率。轻度 CR-AKI 更容易被忽视，在这种情况下，持续的肾脏损伤很常见。在接受化疗的患者中，应强调早期识别 CR-AKI 并进行个体化治疗。
