Prognosis of AKI in malignant diseases with and without sepsis

Abstract

BackgroundAKI significantly worsens prognosis of hospitalized patients. This is particularly the case in patients with sepsis. The risk for aquiring sepsis is significantly increased in malignant diseases. Aim of the present retrospective study was to analyze outcomes of tumor patients with sepsis and AKI.MethodsOne-thousand and seventeen patients, treated at the ICU of the Department of Nephrology and Rheumatology of the University Hospital Göttingen from 2009 to 2011 were retrospectively analyzed for mortality, sepsis, AKI, need for renal replacement therapy (dialysis) and malignancies.ResultsAKI occurred significantly more frequent in septic than in non-septic patients and in tumor as oposed to non-tumor patients. Mortaliy rates were higher in the respective latter groups. Mortality increased even further if patients suffered from a malignant disease with sepsis and AKI. Mortality rates peaked if dialysis treatment became mandatory. In non-solid tumors 100% of the patients died if they suffered drom sepsis and AKI. This was not the case in solid malignancies (mortality rate 56%).ConclusionsWe conclude that prognosis of tumor patients with AKI and sepsis is very poor. Mortality increases to almost 70% if diaylsis therapy is initiated. Non-solid tumors are associated with a 100% mortality if sepsis and AKI conincide.

Critical care of patients with cancer

“…Acute kidney failure occurs in 12% to 36% of patients with cancer and is accompanied by substantial morbidity and mortality . From 16% to 23% of patients with cancer who are admitted to the ICU develop severe renal failure and require renal replacement therapy . The etiology of renal failure in patients with cancer is often multifactorial and can be caused by the tumor itself or by drug‐related toxicity .…”

“…Acute kidney injury in patients with cancer has been associated with a 3‐day longer hospital stay, $42,671 higher hospital costs, and a 4.7‐fold increase in the odds of death . Published survival rates for critically ill patients with cancer requiring renal replacement therapy range from 20% to 50% . In particular, patients with active hematological malignancies and renal impairment have a poor prognosis, presumably because renal impairment negatively affects optimal chemotherapeutic treatment .…”

Acute Kidney Injury in Diabetes Mellitus

“…The lowest survival rates have been reported in patients suffering from a malignant disorder and from sepsis-associated AKI with the need for renal replacement therapy. In this particular group, mortality can exceed even 90% [9]. …”

Cell-Based Therapies in Acute Kidney Injury (AKI)

“…Survival rates decrease with progessive loss of kindey excretory function according to the AKIN-criteria [3]. The lowest survival rates have been identified in subjects with a malignant disease, chemotherapy-associated sepsis and dialysis-requiring AKI (90%) [4]. The 2012 KDIGO guidelines offer criteria for diagnosing AKI, they are based on dynamic changes in the serum creatinine concentration [5].…”