Browsing by Subject "Acute kidney injury"

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    Association Between Adjuvant Chemotherapy and Nephrotoxicity and Kidney Function Monitoring in Elderly Breast Cancer Patients
    (2013-05) Li, Shuling
    Background: Chronic kidney disease (CKD) and cancer are major public health problems in the elderly population. In elderly cancer patients, little is known about chemotherapy-related nephrotoxicity or patterns of CKD screening. The purpose of this dissertation was to evaluate the association between adjuvant chemotherapy (CHEMO) and risks of acute kidney injury (AKI) and CKD and rate of CKD screening in elderly women diagnosed with stages I-III breast cancer. Methods: The study was a 1:1 individually matched, retrospective cohort design using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. Matching was performed at the day of CHEMO initiation based on propensity score. The assembled matched cohorts were used in the analyses for all three objectives with different follow-up periods and statistical methods for each objective. HASH(0x307f974) Results: A total of 28,048 patients were included. CHEMO was associated with a 2.7-fold increased risk of AKI within 6 months after initiation (HR 2.7, 95% CI 1.8-4.1). To find a possible explanation to this association, the distribution of other diseases coded on hospital claims for AKI was examined and showed that septicemia occurred in 40% of CHEMO treated patients with AKI and in only 17% of untreated patients with AKI. No significant association was found between CHEMO and risk of CKD in the maximum 18 years follow-up (HR 1.00, 95% CI 0.93-1.07). The rate of CKD screening after treatment completion was low regardless of CHEMO status. HASH(0x2faf9d4) Conclusion: CHEMO is associated with increased risk of AKI. This association may be partially explained by septicemia caused by infection/neutropenia due to use of myelosuppressive chemotherapeutic agents, which highlights the importance of preventing serious complications of CHEMO in preventing AKI. The finding of no association between CHEMO and risk of CKD may not suggest a late nephrotoxic effect of chemotherapeutic agents commonly used to treat breast cancer in the adjuvant setting, or provide evidence to recommend a clinical practice guideline for CKD screening specifically in elderly breast cancer patients treated with CHEMO. Future studies of CKD as a late effect of cancer treatment for other solid tumors commonly treated with known or potential nephrotoxic agents are warranted.
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    An optimized classification system of acute kidney injury for predicting the short-term mortality after open heart surgery; comparison of current classification systems.
    (2010-05) Afshinnia, Farsad
    Epidemiologic studies need a unique operational definition of acute kidney injury (AKI) to compare outcomes. We aimed to compare prognostic value of change in serum creatinine with classification systems of AKI to predict 30day mortality after heart surgery. From VA database, 27410 eligible patients with stable baseline kidney function who had heart surgery from 1999 to 2005 were selected. There was a graded increase in mortality from stage A to stage C of all systems. Adjusted 30day mortality odds ratio starts to increase significantly after an acute rise ≥ 0.3 mg/dL of creatinine in CKD stages 1 and 2, and after 0.6 mg/dL increase in CKD stage 3. Area under ROC curve of change of creatinine from baseline was significantly higher than those of classification systems (P<0.001). In conclusion, compared to continuous increase of creatinine, classification systems of AKI misestimate mortality risk by collapsing predictive, clinically important data into categories.