We have discussed earlier in this forum about kidney injury as a result of treatment of acute coronary syndrome. Now we are informed that chemotherapy too is not safe. The moral of the story is that we should always keep a watch on the state of the kidney during any treatment. Usually the early state of renal disease is silent unless we look for it. What I advise is even if renal function tests are within normal limit after a course of any treatment you should repeat the basic tests lest we may inadvertently allow the condition to a state when we may not be able to do much.

Acute kidney injury common during chemotherapy

Reuters Health News | December 18, 2018

Nearly one in 10 cancer patients treated with chemotherapy or newer targeted drugs may be hospitalized for acute kidney injury, a Canadian study suggests.

The study involved roughly 163,000 patients who started chemotherapy or targeted therapies for a new cancer diagnosis in Ontario from 2007 to 2014. Overall, 10,880 were hospitalized with acute kidney injury. The cumulative acute kidney injury rate was 9.3%, the study found.

People with advanced tumors were 41% more likely to have acute kidney injuries than patients with early-stage cancer.

Compared to the group as a whole, individuals with chronic kidney disease were 80% more likely to be hospitalized for acute kidney failure, and people with diabetes had a 43% greater chance.

“Patients should be aware that kidney injury can result during cancer treatment—both due to cancer itself and the drugs used to treat it,” said lead study author Dr. Abhijat Kitchlu of the University of Toronto.

“It may be possible to reduce the risk of acute kidney injury by maintaining good hydration and in some cases, avoiding other drugs that can increase risk to the kidneys,” Kitchlu added.

In the study, older patients taking diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers were also at higher risk for serious kidney problems.

“Patients should seek early medical attention when concerned about dehydration or infection, as the symptoms related to kidney injury (decreased urine output, swelling, nausea, fatigue or confusion) may only occur after the kidneys have been damaged,” Kitchlu advised.
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In the current study, patients were more than twice as likely to develop acute kidney problems within the first 90 days of starting cancer treatment than they were later on, researchers reported November 13 online in the Journal of the National Cancer Institute.

Patients at high risk of kidney damage may be able to take cancer drugs that are less likely to damage the kidneys, said Leah Siskind, of the University of Louisville Medical School in Kentucky.

“However, these less nephrotoxic chemotherapeutics are often less effective at reducing tumor burden,” Siskind, who wasn’t involved in the study, said by email.

—Lisa Rapaport