[Renal Replacement Therapy in Cancer Patients with AKI]

Area of Science:

• Nephrology
• Oncology
• Critical Care Medicine

Context:

• Acute kidney injury (AKI) is a significant complication in cancer patients, affecting 18% in the first year and 27% by the fifth year post-diagnosis.
• Critically ill cancer patients have a 40% likelihood of requiring renal replacement therapy (RRT).
• Causes of AKI in cancer are multifactorial, including pre-renal issues, cancer-related problems, metabolic disturbances, and treatment side effects (drugs, surgery).

Purpose:

• To outline the preventive strategies for renal function in cancer patients.
• To detail the diagnostic evaluation for AKI in this population.
• To discuss the management of AKI, including RRT modalities and extracorporeal circuit anticoagulation.

Summary:

• Preventive measures include hydration, avoiding nephrotoxic agents, correcting anemia, preventing contrast-induced AKI (CI-AKI), and adjusting cancer therapy in patients with chronic kidney disease (CKD).
• Essential evaluations involve baseline renal function, creatinine trends, electrolytes, urinalysis, proteinuria, imaging, and potentially renal biopsy.
• Management requires a timely, multidisciplinary approach, including initiating RRT (IHD, PIRRT, CRRT) and optimizing CRRT with regional citrate anticoagulation (RCA) for better circuit function and patient outcomes.

Impact:

• An integrated onco-nephrologic approach is crucial for reducing the high mortality rates associated with AKI in cancer patients.
• Optimizing RRT, particularly CRRT with RCA, improves anticoagulation, reduces circuit clotting, and minimizes downtime.
• Timely and comprehensive management can significantly improve outcomes and reduce mortality in this vulnerable patient group.