Outcomes of cancer and non-cancer patients with acute kidney injury and need of renal replacement therapy admitted to general intensive care units

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2011-02, Vol.26 (2), p.537-543
• Main Authors: MACCARIELLO, Elizabeth, VALENTE, Carla, NOGUEIRA, Lina, BONOMO, Helio, ISMAEL, Marcia, MACHADO, Jose Eduardo, BALDOTTO, Fernanda, GODINHO, Marise, ROCHA, Eduardo, SOARES, Marcio
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - complications; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical Care; Critical Illness; Emergency and intensive care: renal failure. Dialysis management; Female; Hospital Mortality; Humans; Intensive care medicine; Intensive Care Units; Male; Medical sciences; Middle Aged; Neoplasms - complications; Prospective Studies; Renal Replacement Therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Treatment Outcome
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfq441

Studies on cancer patients with acute kidney injury (AKI) are restricted to specialized intensive care units (ICUs). The aim of this study was to compare the characteristics and outcomes of cancer and non-cancer patients requiring renal replacement therapy (RRT) for AKI in general ICUs. A prospective cohort study was conducted in 14 ICUs from three tertiary care hospitals. A total of 773 (non-cancer 85%; cancer 15%) consecutive patients were included over a 44-month period. Logistic regression was used to identify factors associated with hospital mortality. Continuous RRT was used in 79% patients. The main contributing factors for AKI were sepsis (72%) and ischaemia/shock (66%); AKI was multifactorial in 87% of cancer and in 71% non-cancer patients. Hospital mortality rates were higher in cancer (78%) than in non-cancer patients (68%) (P=0.042). However, in multivariate analyses, older age, medical admission, poor chronic health status, comorbidities, ICU days until the RRT start and number of associated organ dysfunctions were associated with hospital mortality. The diagnosis of cancer was not independently associated with mortality [odds ratio=1.54 (95% confidence interval, 0.88-2.62), P=0.115]. Mortality in cancer patients was mostly dependent on the number of associated organ dysfunctions. Of note, 85% cancer patients recovered renal function at hospital discharge. In general ICUs, one in six patients requiring RRT has cancer. Despite a relatively higher mortality, the presence of cancer was not independently associated with mortality in the present cohort.