Tool may help predict risk for kidney injury after chemotherapy
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Researchers at Brigham and Women’s Hospital developed a tool that predicts risks for moderate to severe kidney injury after treatment with the chemotherapy drug cisplatin.
In a paper published in The BMJ, investigators described the development and validation of a comprehensive tool developed in collaboration with researchers at Dana-Farber Cancer Institute and other institutions.
The study — described in a press release as the largest study of its kind — showed that patients at the highest risk for moderate to severe kidney injury after cisplatin had up to a 20-fold higher risk than those in the lowest-risk group.
“We hope that providers and patients will begin utilizing this calculator to determine an individual's risk for kidney injury,” senior author David E. Leaf, MD, MMSc, director of clinical and translational research in acute kidney injury at Brigham and Women’s division of renal medicine, told Healio. “Patients who are at highest risk should discuss the risks and benefits of cisplatin with their provider, as they may need closer monitoring, dose adjustment or reduction of cisplatin, and possibly consideration of alternative therapies.”
Healio spoke with Leaf and first author Shruti Gupta, MD, MPH, director of onco-nephrology at Brigham and Women’s Hospital and Dana-Farber Cancer Institute, about the need for this tool and how clinicians can access and use the tool to predict which patients may be at the greatest risk.
Healio: How common is kidney injury after cisplatin chemotherapy, and what impact does it have on morbidity and mortality?
Gupta: The true incidence of kidney injury after cisplatin is difficult to determine because the definitions of kidney injury — as well as patient populations and number of cycles of cisplatin administered — vary across studies. However, the incidence of kidney injury is thought to be anywhere from 3% to 30%, depending on how it’s defined. In our study, which focused on moderate to severe kidney injury, the incidence was 3% to 5%. We know that kidney injury in other contexts — such as among patients who are critically ill or have sepsis — is associated with mortality. We found this in our own study, where the risk for death at 90 days was several-fold higher among patients with cisplatin-associated kidney injury than those without it.
Healio: What methods, if any, are available to predict risk?
Leaf: Previous studies have examined risk factors for kidney injury after cisplatin; however, our risk prediction model is more accurate and generalizable than prior models for several reasons. First, we externally validated our findings using data from patients treated across cancer centers that were different from the center from which our model was developed. Second, we specifically focused on moderate to severe kidney injury — the most clinically relevant form — as opposed to previous studies, which focused on milder kidney damage. Third, our study included data from almost 25,000 patients treated with cisplatin, which is larger than all prior studies combined. We also are the first to develop an online risk calculator that can be used to determine an individual's risk for kidney injury.
Healio: How did you develop your institution’s risk prediction model? What factors does it consider?
Gupta: We contacted collaborators at other major cancer centers, gathering detailed data on patients treated with their first dose of IV cisplatin. We then devoted considerable time to cleaning and validating the data. Specifically, we first derived our model using data from patients treated at Memorial Sloan Kettering Cancer Center, and we validated it using data from five other major cancer centers. We incorporated clinically useful and readily available variables such as laboratory values, comorbidities and cisplatin dose.
Healio: How well has this model performed so far? How have you studied it?
Leaf: We compared our model with previous risk prediction models using formal statistical techniques and found that our model considerably outperformed others with regards to predicting an individual's risk for kidney injury. We found that patients in the highest risk group had 20-fold higher odds of developing kidney injury compared with patients in the lowest risk group.
Healio: Is this model available for use, or does it need to be refined further? What questions still need to be answered questions?
Gupta: The model is available for use, and we hope it will be available soon on MDCalc’s website, as well. Several unanswered questions remain, such as whether certain medications given prior to IV cisplatin help prevent kidney injury. For example, we are performing a randomized clinical trial examining whether high-dose IV magnesium administration prevents cisplatin-associated kidney injury among patients with mesothelioma.
References:
- Brigham and Women’s Hospital. Researchers create new tool for assessing risk of kidney injury after chemotherapy (press release). Available at: https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=4675. Published March 27, 2024. Accessed April 22, 2024.
- Cisplatin-associated acute kidney injury risk calculator. Available at: https://kidneycalc.org/cp-aki-calculator/.
- Gupta S, et al. BMJ. 2024; doi:10.1136/bmj-2023-077169.
For more information:
David E. Leaf, MD, MMsc, can be reached at deleaf@bwh.harvard.edu.
Shruti Gupta, MD, MPH, can be reached at shrutigkidney@gmail.com.
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