Chen Yi-Ting, Kuo Yao-Hung, Lin Chih-Feng, Wang Chun-Wei, Tsai Chiao-Ling
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Blood Purification, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
BMC Nephrol. 2025 Jun 3;26(1):274. doi: 10.1186/s12882-025-04195-z.
The incidence of acute kidney injury (AKI) is high among head and neck cancer (HNC) patients following Platinum-based concurrent chemo-radiotherapy (CCRT). However, the effect of renin-angiotensin-aldosterone system (RAAS) blockade on the risk of AKI in HNC patients undergoing CCRT is controversial. This study aimed to investigate the association between RAAS blockade, AKI and survival in HNC patients undergoing CCRT.
This retrospective cohort study included 989 HNC patients treated between January 2016 and July 2022, with follow-up extending to July 2022. Among them, 65 (6.6%) patients were using RAAS blockade for hypertension control, while 924 were non-users. Clinical data and demographics were retrieved. Cox regression models were employed to analyze primary outcomes, including AKI and patient survival.
There were 65 (6.6%) patients being RAAS blockade users in the study. The mean age of RAAS blockade users was older than that of non-users (61 vs. 55 years old, p < 0.001). Overall, 219 (22.1%) patients developed AKI, including 25 RAAS blockade users. RAAS blockade users had a higher risk of AKI compared to non-users (38% vs. 21%, p = 0.001) and also had a worse mortality rate (35% vs. 22%, p = 0.015). Factors such as male gender, age, RAAS blockade usage, and baseline serum creatinine levels independently predicted the onset of AKI and patient survival.
RAAS blockade users developed AKI, which significantly predicted patient survival. Diligent post-CCRT renal function monitoring and hydration in RAAS blockade users are crucial to mitigate AKI risk and potentially improve survival in this patient group.
在接受铂类同步放化疗（CCRT）的头颈癌（HNC）患者中，急性肾损伤（AKI）的发生率很高。然而，肾素-血管紧张素-醛固酮系统（RAAS）阻断对接受CCRT的HNC患者发生AKI风险的影响存在争议。本研究旨在探讨RAAS阻断、AKI与接受CCRT的HNC患者生存之间的关联。
这项回顾性队列研究纳入了2016年1月至2022年7月期间接受治疗的989例HNC患者，随访至2022年7月。其中，65例（6.6%）患者使用RAAS阻断剂控制高血压，924例未使用。收集临床数据和人口统计学资料。采用Cox回归模型分析主要结局，包括AKI和患者生存情况。
本研究中有65例（6.6%）患者使用RAAS阻断剂。使用RAAS阻断剂的患者平均年龄高于未使用者（61岁对55岁，p<0.001）。总体而言，219例（22.1%）患者发生了AKI，其中包括25例使用RAAS阻断剂的患者。与未使用者相比，使用RAAS阻断剂的患者发生AKI的风险更高（38%对21%，p=0.001），死亡率也更高（35%对22%，p=0.015）。男性、年龄、使用RAAS阻断剂和基线血清肌酐水平等因素独立预测了AKI的发生和患者生存情况。
使用RAAS阻断剂的患者发生了AKI，这显著预测了患者生存情况。对使用RAAS阻断剂的患者进行CCRT后肾功能的密切监测和补液对于降低AKI风险以及潜在改善该患者群体的生存至关重要。
