J Natl Cancer I: 癌症相关急性肾损伤发生率7年间增加了4倍

2019-03-04 贾朝娟 环球医学

在当代,有关癌症治疗相关急性肾损伤(AKI)发病率和风险因素研究数据较少。2018年11月,发表在《J Natl Cancer Inst》的一项基于人群的队列研究,对此进行了考察。结果显示,2007至2014年间AKI年度发生率增加了4倍。

在当代,有关癌症治疗相关急性肾损伤(AKI)发病率和风险因素研究数据较少。2018年11月,发表在《J Natl Cancer Inst》的一项基于人群的队列研究,对此进行了考察。结果显示,2007至2014年间AKI年度发生率增加了4倍。

背景:接受癌症治疗的患者急性肾损伤(AKI)风险增加。在当代癌症治疗中,有关AKI发病率和风险因素的数据较少。

方法:研究者对加拿大安大略(2007-2014)新诊断为癌症且接受系统性治疗(化疗或靶向药)的所有患者开展了一项基于人群的研究。主要结局指标是因发生AKI住院或接受急性透析治疗。校正人口统计学、癌症特征、并发症和合并处方后,研究者估算了AKI的累积发病率,并拟合了精细和灰色模型。研究者构建模型,将暴露于系统性治疗(治疗后90日)作为时变协变量。研究者还评估了每年AKI发病率的时间趋势。

结果:在163071名开始系统性治疗的患者中,研究者识别出10880例发生AKI的患者。AKI发生率是每1000人-年27例,总的累积发生率为9.3%(95%CI=9.1%~9.6%)。5年AKI发生率最高的恶性肿瘤是骨髓瘤(26.0%,95%CI=24.4%~27.7%)、膀胱癌(19.0%,95% CI = 17.6%~20.5%)和白血病(15.4%,95% CI = 14.3%~16.5%)。晚期癌症、慢性肾病和糖尿病与AKI风险增加相关(校正风险比[aHR]=1.41,95%=1.28~1.54;1.80,95%CI=1.67~1.93;和1.43,95%CI=1.37~1.50)。在66岁或以上具有广泛药物获益的患者中,同时处方利尿剂和血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂与AKI风险较高相关(aHR=1.20,95%CI=1.14~1.28;1.30,95%CI=1.23~1.38)。接受系统治疗后90日内AKI发生风险进一步加剧(aHR=2.34,95%CI=2.24~2.45)。2007至2014年间AKI年度发生率从每1000人-年18例增加到52例。

结论:癌症相关AKI是常见的,并且与晚期、慢性肾脏疾病、糖尿病,以及同时接受利尿剂或血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂相关。在系统治疗后90日内风险增加。需要制定预防措施,以解决这一人群中AKI发生风险增加所带来的负担。

环球医学:

Kitchlu A, McArthur E, Amir E, et al. Acute Kidney Injury in Patients Receiving Systemic Treatment for Cancer: A Population-Based Cohort Study. J Natl Cancer Inst. 2018 Nov 13. doi: 10.1093/jnci/djy167.

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    2019-07-25 qidongfanjian
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