1Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
2Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
3Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
4Department of Computer Science and Engineering, Seoul National University College of Engineering, Seoul, Korea
5Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
6Department of Statistics, Keimyung University, Daegu, Korea
7Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea
8Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
9Department of Biomedical Engineering, Seoul National University, Seoul, Korea
Copyright © 2021 by the Korean Cancer Association
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Baseline characteristics according to AKI stage
Characteristic | Total (n=3,202) | No AKI (n=1,783) | AKI stage 1 (n=1,351) | AKI stage 2/3 (n=68) | p for trend |
---|---|---|---|---|---|
Age (yr) | 63.8±10.3 | 62.9±10.7 | 64.8±9.8 | 66.0±8.7 | < 0.001 |
Female sex (%) | 31.4 | 36.6 | 24.6 | 28.6 | < 0.001 |
BMI | |||||
Normal weight |
68.7 | 68.4 | 69.3 | 67.6 | 0.612 |
Underweight |
3.5 | 3.2 | 4.0 | 2.9 | |
Overweight |
25.7 | 26.5 | 24.6 | 25.0 | |
Obesity |
2.1 | 2.0 | 2.1 | 4.4 | |
SBP (mmHg) | 123.7±16.5 | 123.0±16.2 | 124.3±16.6 | 126.4±18.8 | 0.038 |
DBP (mmHg) | 76.0±11.3 | 76.0±11.2 | 76.0±11.4 | 74.5±10.2 | 0.531 |
Diabetes mellitus (%) | 13.8 | 10.7 | 17.4 | 22.9 | < 0.001 |
Smoking history (%) | 32.9 | 30.6 | 35.6 | 37.1 | 0.010 |
Initial eGFR < 60 (mL/min/1.73 m2) (%) | 11.0 | 7.4 | 15.4 | 16.2 | < 0.001 |
Anemia (%) |
31.9 | 26.4 | 38.6 | 44.1 | < 0.001 |
Calcium (mg/dL) | 9.1±0.6 | 9.1±0.6 | 9.0±0.6 | 8.9±0.6 | < 0.001 |
Phosphorus (mg/dL) | 3.4±0.6 | 3.5±0.6 | 3.4±0.6 | 3.4±0.8 | < 0.001 |
Sodium (mmol/L) | 138.8±3.5 | 139.0±3.2 | 138.6±3.8 | 138.7±3.5 | 0.001 |
Potassium (mmol/L) | 4.2±0.4 | 4.2±0.4 | 4.3±0.5 | 4.2±0.5 | < 0.001 |
Chloride (mmol/L) | 102.9±3.7 | 103.0±3.4 | 102.9±4.0 | 102.5±3.9 | 0.433 |
Total CO2 (mmol/L) | 26.0±3.1 | 26.2±2.9 | 25.8±3.2 | 25.5±3.4 | < 0.001 |
Uric acid (mg/dL) | 4.9±1.6 | 4.8±1.5 | 5.1±1.7 | 4.9±1.8 | 0.001 |
Albumin (g/dL) | 4.0±0.5 | 4.0±0.5 | 3.9±0.5 | 3.8±0.5 | < 0.001 |
Alkaline phosphatase (IU/L) | 86.0±69.4 | 83.4±64.7 | 89.3±76.1 | 85.1±40.9 | 0.061 |
CT count/yr | 4.3±3.9 | 3.7±3.6 | 5.0±4.0 | 5.3±3.8 | < 0.001 |
Values are presented as mean±SD unless otherwise indicated. AKI, acute kidney injury; BMI, body mass index; CT, computed tomography; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; Hb, hemoglobin; SBP, systolic blood pressure.
a)Underweight: BMI < 18 kg/m2, normal weight: 18 ≤ BMI < 25 kg/m2, overweight: 25 ≤ BMI < 30 kg/m2, obesity: ≥ 30 kg/m2,
b)Anemia: Hb < 12 g/dL (if female), Hb < 13 g/dL (if male).
Cancer specific characteristics according to AKI stage
Total (n=3,202) | No AKI (n=1,783) | AKI stage 1 (n=1,351) | AKI stage 2/3 (n=68) | p for trend | |
---|---|---|---|---|---|
Pathology (%) | |||||
Adenocarcinoma | 56.2 | 60.9 | 50.3 | 50.0 | < 0.001 |
Squamous cell carcinoma | 23.1 | 20.0 | 27.3 | 21.4 | |
Small cell carcinoma | 10.6 | 8.1 | 13.5 | 15.7 | |
Others | 10.1 | 10.9 | 8.9 | 12.9 | |
SEER stage (%) | |||||
0, 1 (localized or in situ) | 23.3 | 26.5 | 19.2 | 21.4 | < 0.001 |
2, 3, 4, 5 (regional) | 35.9 | 34.4 | 28.2 | 32.9 | |
7 (distant) | 27.6 | 25.6 | 30.1 | 31.4 | |
9 (unknown) | 13.1 | 13.5 | 12.5 | 14.3 | |
Treatment (%) | |||||
Surgery yes, chemotherapy no | 25.8 | 31.0 | 19.2 | 18.6 | 0.008 |
Surgery yes, chemotherapy yes | 24.9 | 21.7 | 29.2 | 20.0 | |
Surgery no, chemotherapy yes | 38.6 | 32.7 | 45.7 | 51.4 | |
Surgery no, chemotherapy no | 10.8 | 14.5 | 5.9 | 10.0 | |
Nephrotoxic chemotherapeutic agents (%) |
53.6 | 53.1 | 54.0 | 58.8 | 0.589 |
Values are presented as percentage. AKI, acute kidney injury; SEER, Surveillance, Epidemiology, and End Results.
a)Nephrotoxic chemotherapeutic agents: cisplatin, carboplatin, ifosfamide, gemcitabine, pemetrexed.
Characteristics of lung cancer patients with severe AKI
No. (%) (n=68) | |
---|---|
Pathology | |
Adenocarcinoma | 33 (48.5) |
Squamous cell carcinoma | 15 (22.0) |
Small cell carcinoma | 11 (16.2) |
Others | 9 (13.2) |
Cause of AKI | |
Septic | 30 (44.1) |
Ischemic | 15 (22.1) |
Postoperative | 8 (11.8) |
Toxic |
6 (8.8) |
Cardiorenal | 2 (2.9) |
Others | 7 (10.3) |
Renal replacement therapy | 3 (4.4) |
Admission to intensive care unit | 11 (16.2) |
Improvement of AKI | 63 (92.6) |
Death | 10 (14.7) |
AKI, acute kidney injury.
a)Contrast-induced nephropathy (2), platinum (2), gemcitabine (1), vancomycin (2).
Cox proportional hazard analysis for all-cause mortality in lung cancer patients
Univariate | Model 1 |
Model 2 |
Model 3 | |||||
---|---|---|---|---|---|---|---|---|
|
|
|
| |||||
HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | |
No AKI | 1 (reference) | 1 (reference) | 1 (reference) | 1 (reference) | ||||
| ||||||||
AKI stage 1 | 1.32 (1.179–1.476) | < 0.001 | 1.19 (1.058–1.330) | 0.004 | 1.18 (1.047–1.322) | 0.006 | 1.15 (1.022–1.292) | 0.020 |
| ||||||||
AKI stage 2, 3 | 1.88 (1.304–2.715) | < 0.001 | 1.78 (1.230–2.567) | 0.002 | 1.76 (1.217–2.551) | 0.003 | 1.73 (1.194–2.505) | 0.004 |
AKI, acute kidney injury; CI, confidence interval; HR, hazard ratio.
a)Model 1: age, sex adjusted,
b)Model 2: model 1+BMI, smoking, initial eGFR, anemia, hyponatremia adjusted,
c)Model 3: model 2+pathologic subtype adjusted.
Long-term kidney outcome according to incident AKI
No AKI (n=1,783) | AKI stage 1 (n=1,351) | AKI stage 2/3 (n=68) | Total (n=3,202) | p-value | |
---|---|---|---|---|---|
CKD occurrence |
18 (1.0) | 192 (14.2) | 16 (23.5) | 226 (7.1) | < 0.001 |
CKD worsening |
1,397 (78.4) | 1,108 (82.0) | 59 (86.8) | 2,564 (80.1) | < 0.001 |
ESKD progression | 0 | 18 (1.3) | 3 (4.4) | 21 (0.7) | < 0.001 |
Values are presented as number (%). AKI, acute kidney injury; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease.
a)CKD occurrence: initial eGFR ≥ 60 mL/min/1.73 m2 and last eGFR < 60 mL/min/1.73 m2,
b)CKD worsening: last CKD stage worse than initial CKD stage.
Values are presented as mean±SD unless otherwise indicated. AKI, acute kidney injury; BMI, body mass index; CT, computed tomography; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; Hb, hemoglobin; SBP, systolic blood pressure. Underweight: BMI < 18 kg/m2, normal weight: 18 ≤ BMI < 25 kg/m2, overweight: 25 ≤ BMI < 30 kg/m2, obesity: ≥ 30 kg/m2, Anemia: Hb < 12 g/dL (if female), Hb < 13 g/dL (if male).
Values are presented as percentage. AKI, acute kidney injury; SEER, Surveillance, Epidemiology, and End Results. Nephrotoxic chemotherapeutic agents: cisplatin, carboplatin, ifosfamide, gemcitabine, pemetrexed.
AKI, acute kidney injury. Contrast-induced nephropathy (2), platinum (2), gemcitabine (1), vancomycin (2).
AKI, acute kidney injury; CI, confidence interval; HR, hazard ratio. Model 1: age, sex adjusted, Model 2: model 1+BMI, smoking, initial eGFR, anemia, hyponatremia adjusted, Model 3: model 2+pathologic subtype adjusted.
Values are presented as number (%). AKI, acute kidney injury; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease. CKD occurrence: initial eGFR ≥ 60 mL/min/1.73 m2 and last eGFR < 60 mL/min/1.73 m2, CKD worsening: last CKD stage worse than initial CKD stage.