SAT-337 ACUTE KIDNEY INJURY IN PATIENTS WITH SOLID ORGAN AND HAEMATOLOGICAL MALIGNANCIES: A SINGLE CENTRE EXPERIENCE

Abstract

Acute kidney injury(AKI) is common in patients with malignancies, both solid organ and haematological malignancies. The aim of this study was to look at the incidence of acute kidney injury and its clinical correlates in patients with haematological and solid organ malignancies receiving chemotherapy. Population: All patients, more than 18 years of age receiving outpatient chemotherapy for solid organ and haematological malignancies at our hospital from Jan 2016 to Dec 2016. Data collected using MOSAIQ( Local Oncology Database) and Hospital Database. Patients were retrospectively followed up during the course of the year for acute kidney injury, which was identified using Creatinine measurements recorded in the lab database. Incidence of acute kidney injury was computed and its causes and clinical correlates were analysed using univariate analysis and multivariate analysis. AKI was defined using rifle criteria, serum Creatinine part of the definition. Injury was defined as Creatinine rise upto 50% above baseline. Results: 592 patients were included in the study. Most common malignancies were bowel cancer followed by breast. Acute kidney injury during the one year course of chemotherapy was seen in 158 patients (27.24%). Pre-renal acute kidney injury was seen in 82 patients (51.8%) and intrinsic renal in 20 patients (12.65%) and post renal cause in 35 patients (22.15%). In 21 patients (13.31%) of study population, cause of acute kidney injury was not identified. When we subclassified each of the causes, sepsis was the most common cause of acute kidney injury seen in 31 patients (19.6%), followed by hypovolumia in 24 patients (15.1%). Bilateral hydronephrosis occurred in 23 patients (14.5%). Interestingly there were 13 patients where the acute kidney injury was attributed to drugs. 5 patients had NSAIDS exposure and 8 patients had chemotherapeutic drug causing AKI. The chemotherapy drugs were Lenalidomide, Methotrexate, Ibrutinib, Pamidronate, Gemcitabine, Vemurafinib and Crizotinib. Patients with acute kidney injury attributed to above drugs had either a dose reduction or change in chemotherapy regimen. None of the patients had a renal biopsy to confirm drug induced pathology. However all of the patients had resolution of acute kidney after stopping the drug or changing the regimen. Also of note, only one patient with pamidronate induced acute kidney injury was referred to nephrology service. Looking at individual cancer types, 5 out of 10 patients (50%) with RCC developed acute kidney injury followed by lymphoma ( n=22, 43%) prostate (n=17, 41%) and myeloma(n=15, 39%). Although bowel and breast cancer were the two most common cancers, proportion of AKI in this group was (n=41,29%) and( n=6, 7%) respectively. Factors associated with acute kidney injury, higher ECOG score, diabetes and hypertension were associated with higher risk of developing acute kidney injury. Contrast to other published papers, having metastatic disease was not associated with higher risk of acute kidney injury. Acute kidney injury is associated with increased mortality. We observed the same trend in our study. Without adjusting for confounding factors, mortality in the acute kidney group at 6, 12 and 18 months was 15%, 31% and 46% compared to Non AKI group which was 5%, 26% and 43%. AKI is common in patients with malignancies and its associated with mortality.