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Researchers create new kidney injury risk assessment tool
Using patient data from six major U.S. cancer centers, researchers developed a risk prediction model for moderate-to-severe kidney injury after receiving cisplatin chemotherapy
Cisplatin is a highly effective chemotherapy that has been used to treat cancer for decades, but it can cause kidney injury that can potentially lead to the discontinuation of life-saving cancer treatments. Investigators from Northwell Health and the Feinstein Institutes for Medical Research, along with Brigham and Women’s Hospital (BWH), Dana-Farber Cancer Institute and other institutions, developed a comprehensive tool to predict which patients are at highest risk of moderate-to-severe kidney injury after cisplatin. They found that the highest-risk patients had as much as a 20-fold higher risk of developing kidney injury after cisplatin than those in the lowest-risk group. Their results are published in The BMJ.
“This large, multicenter collaboration is an important step in defining risk factors for patients who get cisplatin induced kidney injury. This study also led to creation of a risk prediction calculator for cisplatin induced kidney injury, which is an important step in the care of patients who are getting cisplatin,” said Kenar Jhaveri, MD, professor of medicine and associate chief in the Division of Kidney Diseases and Hypertension at Northwell Health and co-author of the paper. “We hope this will help our patients with cancer who get cisplatin — a commonly used chemotherapy agent.”
The researchers examined data from over 24,000 patients across six major U.S. cancer centers, including:
- Dana-Farber Brigham Cancer Center (MA)
- Mass General Cancer Center (MA)
- Memorial Sloan Kettering Cancer Center (NY)
- MD Anderson Cancer Center (TX)
- University of Colorado (CO)
- Northwell Health (NY)
They analyzed the risk of moderate-to-severe acute kidney injury within the first 14 days following a single, first IV dose of cisplatin. The model developed by the research team included several important risk factors for kidney injury including age, high blood pressure, diabetes, laboratory findings from routinely available bloodwork, and higher doses of cisplatin. They found that patients who developed kidney injury from cisplatin had a considerably higher risk of death compared to those who did not.
“Cisplatin is a critical component of our management of cancers arising from the bladder, brain, lung, head and neck, ovaries, and testicles and can be curative in some settings. The use of this agent comes at significant risk, however, of kidney toxicity,” said Richard D. Carvajal, MD, deputy physician-in-chief and director of medical oncology at Northwell Health Cancer Institute. “The work by Drs. Kenar D. Jhaveri and Jamie Hirsch from Northwell Health along with their collaborators provides treating oncologists with a robust tool to identify those patients at greatest risk of such toxicity, allowing providers now to more accurately weigh risks and benefits of cisplatin based therapy with their patients, consider steps to mitigate nephrotoxicity, and assess whether alternative treatment strategies should be utilized.”
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Another key finding was that lower levels of magnesium were an important risk factor for acute kidney injury. The researchers plan to use the same rich database to try to identify therapies that might prevent kidney injury, including magnesium.
Using the risk score, the research team created a simple online calculator that will be made available for use at MDCalc.com. A patient or physician can use this calculator to quantify the risk of kidney injury by inputting information, including whether the patient has high blood pressure, diabetes, or other diseases or medical conditions, along with results from their bloodwork.
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