Prevalence and Risk Factors of Nephrotoxicity Among Adult Cancer Patients at Mbarara Regional Referral Hospital

Abstract

Background: Nephrotoxicity is common among cancer patients, yet some anti-cancer drugs, for example, platinum derivatives, are nephrotoxic and have narrow therapeutic indices. If nephrotoxicity is not managed, it can progress to kidney injury, which results in unregulated blood pressure, hormonal imbalance, electrolyte imbalance, body fluid imbalance and death. However, the burden of nephrotoxicity among adult cancer patients in Uganda is not documented in the literature. Objective: This study assessed the prevalence and risk factors of nephrotoxicity among cancer patients receiving chemotherapy at Mbarara Regional Referral Hospital Cancer Unit (MRRHCU). Methods: The study was a cross-sectional study carried out at the MRRHCU, Uganda. All the 206 adult cancer patients who received at least three cycles of chemotherapy and fulfilled the inclusion criteria were included. A data collection form was used to collect data, which was recorded into Microsoft Excel version 2013. Data were analyzed using Stata version 12.1. Results: Of the 206 participants, 74 (35.9%) developed nephrotoxicity with majority in stage 1 (n = 83, 40.3%) and stage 2 (n = 55, 26.7%). In the multivariate logistic regression of risk factors for nephrotoxicity, age >50 years old (aOR: 1.80, 95% CI: 1.06, 1.91; p > 0.001), hypertension (aOR: 1.71, 95% CI: 1.74, 1.94; p = 0.011) and use of platinum agents (aOR: 2.04, 95% CI: 1.82, 3.34; p = 0.002) were significant independent risk factors of nephrotoxicity. Conclusion: About one-third (1/3) of the adult cancer patients at MRRHCU develop nephrotoxicity, which indicates a high burden of nephrotoxicity. The prevention of progression of nephrotoxicity from grades 0, 1 or 2 to grade 3 or 4 is therefore necessary, especially among the patients with risk factors, such as hypertension and age >50 years old and use of platinum agents.

Pressure Ulcers and associated factors among adult patients admitted to The Surgical Wards in the Comprehensive Specialized Hospital Of The Northwest Amhara Regional State, Ethiopia

“…Patients who had a problem with friction and shear were 5.71 times more at high risk of developing pressure ulcers than those who had no apparent problem with friction or shear. These ndings are consistent with the ndings of studies conducted in Hawassa [32], Pakistan, [50], and, Kenya [51], These ndings revealed that patients who had problems with friction and shear were at greater risk than those with no apparent problems with friction or shear. Possible explanations include the possibility that individuals who fail to keep their body upright on a bed or wheelchair may have their skin slide over the support surface, leading to blood vessel damage, irritation, and skin necrosis, which can cause a pressure ulcer.…”

Cisplatin-induced Nephrotoxicty and its Predisposing Factors for Unrecovered Kidney Injury: A Report from Indonesia National Cancer Center

“…The study in China reported that age 50 and older is associated with cisplatin-induced nephrotoxicity, increased risk up to 11 times [24]. The finding is similar to the result of other study done in Uganda [16]. Older age has higher risk of nephrotoxicity, supported by the fact that older patients are more susceptible due to specific anatomical and functional changes, including kidney vasculature, filtration, and tubulointerstitial function [25].…”

“…The present, retrospective, and cohort study reported that nephrotoxicity is found in almost one third of the population, 45.2% of those who received cisplatin combination chemotherapy. This number is higher to the study by Kidera et al from Japan and Isiiko et al, from Uganda [5], [16], reported a cisplatininduced nephrotoxicity in 32% and 35.9% patients. Two studies from Netherlands found higher prevalence, 53.7% and 69% in head-and-neck cancer patients that treated with high-dose cisplatin.…”

Modulating the Activity of the Human Organic Cation Transporter 2 Emerges as a Potential Strategy to Mitigate Unwanted Toxicities Associated with Cisplatin Chemotherapy

“…Despite the implementation of hydration protocols, CDDP-induced nephrotoxicity presents itself as acute or, in certain instances, chronic kidney injury, leading to life-threatening impairment of kidney function and a need for inclusion into surveillance programs. The prevalence of CDDP-induced nephrotoxicity ranges from 15 to 49%, depending on the study [ 24 , 25 , 26 ] and on the age of the patients [ 27 , 28 ]. Early indications of CDDP nephrotoxicity include a rapid reduction in the renal plasma flow and an elevation in urinary enzymes, which is characteristic of primary tubular toxicity.…”