Relationship between anemia after chemotherapy for cancer and use of diuretics: A descriptive epidemiological study

Diuretics are frequently used for patients with cancer. Anemia is a factor of body fluid retention frequently observed after these patients receive chemotherapy.

To describe the severity of anemia in patients with cancer according to whether diuretics were used after chemotherapy, pursuing evaluation of any relationship between anemia and diuretic use.

In an anonymized electronic medical record database, a study population comprising patients with lung cancer, breast cancer and/or non-Hodgkin lymphoma (NHL) was captured. Observation started on the last date of the first chemotherapy course, and ended on the date for earliest event from death, chemotherapy resumption, loss to follow-up or 180 days since observation started. We collected the lowest hemoglobin level within 90 days since observation started (Measure 1 of anemia) in patients prescribed diuretics for ≥3 days within 180 days since observation started (diuretic-user group) and the remaining population (comparison group). To evaluate association between Measure 1 of anemia and diuretic use, we performed a multivariate analysis in patients with NHL adjusting for age, antihypertensives use, corticosteroid use, renal function, and serum albumin level.

A total of 72,276 patients constituted the population for analysis, with 4809 in the diuretic-user group. Measure 1 of anemia was <8 g/dL and 8-10 g/dL for 24.8% (1194/4809) and 29.4% (1416/4809) of patients in the diuretic-user group, respectively, in contrast to 5.8% (3924/67,467) and 14.4% (9704/67,467) for the comparison group. In the multivariate analysis in patients with NHL, odds ratio for diuretic use was 2.18 (95% confidence interval [CI]: 1.86-2.54) for Measure 1 of anemia in the range of 8-10 g/dL and 4.06 (95% CI: 3.45-4.78) for <8 g/dL, compared to > 10 g/dL.

Our study may contribute to understanding the pathophysiology necessitating diuretic use in patients with cancer.