Impaired renal function and cisplatin-based regimens as risk factors for neoadjuvant chemotherapy-induced acute kidney injury in muscle-invasive bladder cancer: A multicenter retrospective study.

Abstract

760 Background: Neoadjuvant chemotherapy (NAC)-induced acute kidney injury (AKI) is one of the frequent complications in patients with muscle-invasive bladder cancer (MIBC) and we previously have reported the negative impact of NAC-induced AKI on oncological outcomes. However, its risk factors remain unclear. Methods: This multi-institutional retrospective study included 517 patients with MIBC who received 2–4 cycles of NAC followed by radical cystectomy. AKI was defined according to the KDIGO criteria. Patients were divided into two groups: patients who developed any stage AKI during NAC (AKI group) and patients who did not (non-AKI group). Multivariable logistic regression analysis was performed to identify the risk factors for NAC-induced AKI. The predictive abilities for AKI were evaluated using the area under the receiver operating characteristic (ROC) curve. Results: The median age was 69 years. Of the 517 patients, 188 (36%) received cisplatin-based regimens and 92 (18%) developed any stage AKI. Approximately 86% AKI were stage 1 AKI. eGFR in the AKI group was significantly lower than that in the non-AKI group ( P <0.001). The rate of AKI development in patients who received cisplatin-based regimens was significantly higher than that in patients who received carboplatin-based regimens ( P <0.001). In the multivariable analysis, hypertension, impaired renal function, and cisplatin-based regimen were independently and significantly associated with increased risk of AKI (Table). The optimal cutoff value of estimated glomerular filtration rate for AKI was 65.0 mL/min/1.73m 2 . ROC analysis showed that the area under the curve (AUC) of hypertension plus eGFR <65.0 mL/min/1.73m 2 plus cisplatin-based regimen was 0.748 (95% confidence interval: 0.697–0.799). Conclusions: Hypertension, impaired renal function, and cisplatin-based regimens were risk factors for NAC-induced AKI in patients with MIBC. Multivariable analysis for AKI development. Factor P value Odds ratio 95% CI Age Continuous 0.462 0.989 0.959–1.019 Hypertension Presence 0.016 1.894 1.128–3.179 eGFR Continuous <0.001 0.955 0.939–0.971 Cisplatin-based regimens Positive <0.001 6.530 3.725–11.45