Incidence and risk factors for acute kidney injury in head and neck cancer patients treated with concurrent chemoradiation with high-dose cisplatin.
BACKGROUND
Three-weekly high-dose cisplatin (100 mg/m2) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Concurrent chemoradiation (CRT) with high-dose cisplatin is associated with significant acute and late toxicities, including acute kidney injury (AKI). The aims of this study were to investigate the incidence of AKI in patients with LA-SCCHN during and after treatment with high-dose cisplatin-based CRT, to identify risk factors for cisplatin-induced AKI, and to describe the impact of AKI on long-term renal function and treatment outcomes.


METHODS
This is a retrospective cohort study with measurements of renal function before CRT, weekly during CRT, every 1 or 2 days during hospitalizations, and 3 and 12 months after CRT in patients with LA-SCCHN. AKI was defined as increase in serum creatinine (sCr) of ≥1.5 times baseline or by ≥0.3 mg/dL (≥26.5 μmol/L) using the Kidney Disease Improving Global Outcomes (KDIGO) classification. Logistic regression models were estimated to analyze renal function over time and to identify predictors for AKI.


RESULTS
One hundred twenty-four patients completed all measurements. AKI was reported in 85 patients (69%) with 112 episodes of AKI. Sixty of 85 patients experienced 1 AKI episode; 20 patients experienced ≥2 AKI episodes. Ninety-three (83%) AKI episodes were stage 1, 13 (12%) were stage 2, and 6 (5%) AKI episodes were stage 3. Median follow-up time was 29 months (Interquartile Range, IQR 22-33). Hypertension (Odds Ratio, OR 2.7, 95% Confidence Interval, CI 1.1-6.6; p = 0.03), and chemotherapy-induced nausea and vomiting (CINV; OR 4.3, 95% CI 1.6-11.3; p = 0.003) were associated with AKI. In patients with AKI, renal function was significantly more impaired at 3 and 12 months post-treatment compared to patients without AKI. AKI did not have a negative impact on treatment outcomes.


CONCLUSION
AKI occurred in 69% of patients with LA-SCCHN undergoing CRT with high-dose cisplatin. Long-term renal function was significantly more impaired in patients with AKI. Hypertension and CINV are significant risk factors. Optimizing prevention strategies for CINV are urgently needed.
['van der Vorst|Maurice J D L|MJDL|', 'Neefjes|Elisabeth C W|ECW|', 'Toffoli|Elisa C|EC|', 'Oosterling-Jansen|Jolanda E W|JEW|', 'Vergeer|Marije R|MR|', 'Leemans|C René|CR|', 'Kooistra|Menno P|MP|', 'Voortman|Jens|J|', 'Verheul|Henk M W|HMW|http://orcid.org/0000-0002-2971-247X']
D058186:Acute Kidney Injury D000328:Adult D000368:Aged D000970:Antineoplastic Agents D059248:Chemoradiotherapy D002945:Cisplatin D003404:Creatinine D005260:Female D005500:Follow-Up Studies D006258:Head and Neck Neoplasms D006801:Humans D006973:Hypertension D015994:Incidence D008297:Male D008875:Middle Aged D009325:Nausea D012189:Retrospective Studies D012307:Risk Factors D000077195:Squamous Cell Carcinoma of Head and Neck D016896:Treatment Outcome D014839:Vomiting
Risk factors Acute kidney injury Chemoradiation High-dose cisplatin Locally advanced squamous cell carcinoma of the head and neck