Abstract
BackgroundPeptide receptor radionuclide therapy (PRRT) is applied in patients with advanced neuroendocrine tumors. Co-infused amino acids (AA) should prevent nephrotoxicity. The aims of this study were to correlate the incidence of AA-induced hyperkalemia (HK) (≥5.0 mmol/l) and to identify predictors of AA-induced severe HK (>6.0).MethodsIn 38 patients, standard activity of 177Lu-labelled somatostatin analogs was administered. Pre-therapeutic kidney function was assessed by renal scintigraphy and laboratory tests. For kidney protection, AA was co-infused. Biochemical parameters (potassium, glomerular filtration rate, creatinine, blood urea nitrogen (BUN), sodium, phosphate, chloride, and lactate dehydrogenase (LDH)) were obtained prior to 4 and 24 h after the AA infusion. Incidence of HK (≥5.0) was correlated with pre-therapeutic kidney function and serum parameters. Formulas for the prediction of severe hyperkalemia (>6.0) were computed and prospectively validated.ResultsAt 4 h, HK (≥5.0) was present in 94.7% with severe HK (>6.0) in 36.1%. Values normalized after 24 h in 84.2%. Pre-therapeutic kidney function did not correlate with the incidence of severe HK.Increases in K+ were significantly correlated with decreases in phosphate (r = −0.444, p < 0.005) and increases in BUN (r = 0.313, p = 0.056). A baseline BUN of >28 mg/dl had a sensitivity of 84.6% and a specificity of 60.0% (AUC = 0.75) in predicting severe HK of >6.0 (phosphate, AUC = 0.37).Computing of five standard serum parameters (potassium, BUN, sodium, phosphate, LDH) resulted in a sensitivity of 88.9% and a specificity of 79.3% for the prediction of severe HK >6.0 (accuracy = 81.6%).ConclusionsA combination of serum parameters predicted prospectively the occurrence of relevant HK with an accuracy of 81.6% underlining its potential utility for identifying ‘high-risk’ patients prone to PRRT.
Highlights
Peptide receptor radionuclide therapy (PRRT) is applied in patients with advanced neuroendocrine tumors
In a recent study including patients with neuroendocrine tumors (NET) undergoing PRRT with 90Y-DOTATOC, Giovacchini et al reported the incidence of hyperkalemia (>5.0 mmol/l) in more than three-fourths of patients with potassium levels up to 6.7 mmol/l, thereby raising awareness of this potentially life-threatening adverse effect induced by AAcoinfusion [13]
In October 2013, the routinely administered amount of amino acids (AA) was reduced from 75 g to 50 g to comply with the most recent version of the joint International Atomic Energy Agency (IAEA), European Association of Nuclear Medicine (EANM), and Society of Nuclear Medicine and Molecular Imaging (SNMMI) practical guidance [6]
Summary
Peptide receptor radionuclide therapy (PRRT) is applied in patients with advanced neuroendocrine tumors. The aims of this study were to correlate the incidence of AA-induced hyperkalemia (HK) (≥5.0 mmol/l) and to identify predictors of AA-induced severe HK (>6.0). Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin agonists such as 90Y- or 177Lulabelled-[1,4,7,10-tetraazacyclododecane-NN′,N′′,N′′′-tetraacetic acid]-d-Phe1,Tyr3-octreotoc/-tate) DOTATOC/-TATE (is routinely used for advanced and/or metastatic neuroendocrine tumors (NET) which overexpress somatostatin. In a recent study including patients with NET undergoing PRRT with 90Y-DOTATOC, Giovacchini et al reported the incidence of hyperkalemia (>5.0 mmol/l) in more than three-fourths of patients with potassium levels up to 6.7 mmol/l, thereby raising awareness of this potentially life-threatening adverse effect induced by AAcoinfusion [13]. Early or even pre-therapeutic identification of patients at risk for developing severe hyperkalemia (>6.0 mmol/l) due to AA-coinfusion would be of high relevance. The aims of this study were to assess the incidence and severity of hyperkalemia (≥5.0 mmol/l) and to identify predictors of PRRT-related severe hyperkalemia (>6.0 mmol/l)
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