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Acute kidney injury in cancer patients
Wim Van Biesen for
Norbert LameireEm prof of MedicineUniversity Hospital
Gent, Belgium
Tbilisi, october 2015
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Cumulative incidence (risk) of AKI during the first 5 years after a cancer diagnosis
Christiansen et al. / European J Int Med 22 (2011) 399–406
37,267 incident cancer patients -5yrs FU
9613 (25.8%) developed AKI
1-yr risk:17.5% 5-yr risk: 27.0%
mortality
RI
F
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The timing of AKI, presented as percentages of total AKI against days after admission to the
cancer center.
Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013.
* 12% of all admissions to cancer center over 3 month period had AKI* Most cases seen in recent admissions
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Main associated factors of AKI in cancer patients(n: 309)
Soares et al, J Clin Oncol 24:4003-4010, 2006
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Kaplan-Meyer survival curve for 90 days after admission to the cancer center based on AKI severity by RIFLE
Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013
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Length of hospital stay
Hospital bills
Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013
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Length of hospital stay
Hospital bills
Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013
Large confidence intervals
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Effect of AKI on outcomes of cancer patients
Campbell et al, Adv CKD, 2014, 21: 64-71
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Anticancer therapies requiring dosage adjustment as a percentage of prescriptions
(A) and as a percentage of treated patients (B).
Launay-Vacher et al, Cancer 2007;110:1376–1384.
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S crea = 1.5: what about renal function???
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Patient-specific factors that increase risk for chemotherapy- asssociated nephrotoxicity
Shirali, Perazella, Adv CKD , 2014, 21: 56-63,
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Categories of chemotherapy-Induced nephrotoxicity
Perazella, Moeckel, Semin Nephrol 30:570-581, 2010
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Pathophysiology of cisplatinum nephrotoxicity
Pabla N, Dong Z. Kidney Int 73: 994–1007, 2008.
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Magnesium supplementation in prevention of cisplatinum nephrotoxicity
Kidera et al, PLoS ONE 9(7): e101902., 2014
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Comparison of cis-platin with its Second and Third Generation Platinum Analogues
Ali et al , Anti-Cancer Agents in Medicinal Chemistry, 2013, 13, 296-306
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Purine metabolism- uric acid is the endproduct in humans
Wilson, Berns Adv CKD, 2014, 21: 18-26
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The Cairo-Bishop Definitions of laboratory and clinical Tumor Lysis Syndrome
Wilson, Berns Adv CKD, 2014, 21: 18-26
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Reported incidences of TLS stratified by Risk Category
Wilson, Berns Adv CKD, 2014, 21: 18-26
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Flowchart of patients included in thestudy according to the presence of TLS
Darmon et al, British Journal of Haematology, 2013, 162, 489–497
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Prophylaxis and Treatment of Tumor Lysis Syndrome
Denker et al, European J Int Med 22 (2011) 348–354
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Only 1 RCT 7 observational historical control
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Risk of AKI associated with androgen deprivation therapy for advanced prostate
cancer (observational)
Lapi et al , JAMA. 2013;310(3):289-296.
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Cumulative incidence plot depicting the rates of AKI after stratifying patients according to the type of androgen deprivation for non metastatic prostate Ca
(gonadotropin releasing agonists)
Gandaglia et al, EUROPEAN UROLOGY 66 (2014) 1125–1132
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Mechanisms of FLCs-induced kidney injury
Davenport, Merlini, Nephrol Dial Transplant (2012) 27: 3713–3718
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Probability of renal recovery following sustained reduction in free light chain levels at day 21 in myeloma kidney.
Hutchison et al. J. Am. Soc. Nephrol. 22, 1129–1136 © 2011
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Combination of bortezomib-based chemotherapy and extracorporeal free light chain removal for
treating cast nephropathy in MM-2 cases
Bachmann et al, NDT Plus (2008) 2: 106–108
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Figure 2. Forest plot of weighted risk ratio comparing 6-month survival rate between chemotherapy withplasmapheresis and chemotherapy only group.
International Journal of Clinical Pharmacology and Therapeutics, Vol. 53 – No. 5/2015 (391-397)
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Figure 3. Forest plot of weighted risk ratio comparing 6-month dialysis-dependent rate between chemotherapy with plasmapheresis and chemotherapy only group.
International Journal of Clinical Pharmacology and Therapeutics, Vol. 53 – No. 5/2015 (391-397)
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Novel approaches for reducing free light chains in patients with myeloma kidney
Hutchison, C. A. et al. Nat. Rev. Nephrol. 8, 234–243 (2012 )
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General conclusions• Be aware of renal probems in patients with cancer• Acute Kidney Injury• Chronic Kidney injury• Keep it simple:• rehydration• dose-adaptation• most “exciting new promising” therapies NOT
supported by evidence