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Pharmacological Nephrotoxicity Profile in a Comprehensive Cancer Center: What Changed in Two Decades and Predictors for the Need for Haemodialysis and Mortality
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André Ferreira1,a,
Autor para correspondencia
ferreiraandre_5@hotmail.com

Corresponding author: Hospital de São Teotónio (Viseu). Av. Rei D. Duarte, 3504-509, Viseu, Portugal
, Marina Reis2,b, Teresa Chuva3,c, Hugo Ferreira4,d, Inês Coelho5,e, Ana Paiva6,f, José Maximino Costa7,g
1 Division of Nephrology, Department of Medicine. Instituto Português de Oncologia do Porto, FG, E.P.E, Porto, Portugal
2 Department of Nephrology. Unidade Local de Saúde Coimbra, Coimbra, Portugal
3 Division of Nephrology, Department of Medicine. Instituto Português de Oncologia do Porto, FG, E.P.E, Porto, Portugal
4 Division of Nephrology, Department of Medicine. Instituto Português de Oncologia do Porto, FG, E.P.E, Porto, Portugal
5 Division of Nephrology, Department of Medicine. Instituto Português de Oncologia do Porto, FG, E.P.E, Porto, Portugal
6 Division of Nephrology, Department of Medicine. Instituto Português de Oncologia do Porto, FG, E.P.E, Porto, Portugal
7 Division of Nephrology, Department of Medicine. Instituto Português de Oncologia do Porto, FG, E.P.E, Porto, Portugal
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Abstract

Introduction and objectives: Acute kidney injury (AKI) is a frequent and severe complication in hospitalised cancer patients. However, overall data from in-hospital drug-related AKI in cancer patients is scarce. We aim to review the profile of moderate to severe drug-induced AKI in patients admitted to an oncology hospital over the last two decades and to assess renal and overall outcomes.

Material and methods: 410 cases of drug-induced AKI KDIGO≥ 2 were analysed, comparing between two decades from 2002 to 2021 in a comprehensive cancer center.

Results: The main differences were the introduction of new classes of cancer therapy (e.g., immune checkpoint inhibitors [ICPI] and tyrosine kinase inhibitors [TKI]), a decrease in nephrotoxicity due to platinum-based drugs, and an increase in nephrotoxicity caused by multiple drugs without cancer-directed therapy. Mortality was similar, but the need for haemodialysis (HD) was higher in the second decade (25,5% vs 36,6%, p= 0,02). Multivariate analysis presented invasive mechanical ventilation and sepsis as risk factors for both HD and mortality, haematologic cancer as risk factors for HD, and the need for HD and multiple drugs without cancer-directed therapy as risk factors for mortality.

Conclusion: Adequate drug surveillance and prophylaxis render cancer therapy as a relatively small contributor to drug-induced AKI in a comprehensive cancer center. Critically ill patients have a higher need for HD and mortality regardless of the nephrotoxic agent implied.

Keywords:
acute kidney injury
drug nephrotoxicity
onco-nephrology
cancer patients
haemodialysis
mortality
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André Ferreira received his Master’s in Medicine from Instituto de Ciências Biomédicas Abel Salazar in 2016 and is currently a Nephrology Resident at Unidade Local de Saúde Viseu Dão-Lafões.

Marina Reis is a Medical Doctor with specialization in Nephrology, working in the Division of Nephrology of Unidade Local de Saúde Coimbra since 2022, with particular interest in Onconephrology.

Teresa Chuva is a Medical Doctor with specialization in Nephrology, working in the Division of Nephrology of Instituto Português de Oncologia do Porto, FG, E.P.E. since 2011, with particular interest in Onconephrology.

Hugo Ferreira is a Medical Doctor with specialization in Nephrology, working in the Division of Nephrology of Instituto Português de Oncologia do Porto, FG, E.P.E. since 2018, with particular interest in Onconephrology.

Inês Coelho is a Medical Doctor with specialization in Nephrology, working in the Division of Nephrology of Instituto Português de Oncologia do Porto, FG, E.P.E. since 2022, with particular interest in Onconephrology.

Ana Paiva is a Medical Doctor with specialization in Nephrology, working in the Division of Nephrology of Instituto Português de Oncologia do Porto, FG, E.P.E. since 1999, with particular interest in Onconephrology.

José Maximino Costa received his Master’s degree in Medicine from Faculdade de Medicina da Universidade do Porto in 1982, completed his Nephrology Residency at Hospital Geral de Santo António, and is currently the Director of the Division of Nephrology of Instituto Português de Oncologia do Porto, FG, E.P.E.

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