Relationship of Renal Replacement Therapy to Cancer Site: A Hospital-Based Analysis in Osaka, Japan

Cancer patients are at risk for acute kidney injury (AKI) due to anticancer agents, tumor lysis syndrome, sepsis, and contrast-induced nephropathy. Renal replacement therapy (RRT) is associated with longer hospital stays, higher healthcare costs, and significant healthcare resource consumption. Therefore, early detection of severe AKI requiring RRT and the implementation of preventive measures are crucial. We comprehensively evaluated the associations with RRT by cancer site among Japanese cancer patients undergoing treatment through use of Hospital-Based Cancer Registry (HBCR) data linked to administrative data in a multicenter cohort study.

Patients were classified into three groups based on the timing of RRT after the initiation of cancer treatment: acute phase (≤30 days), post-acute phase (after 30 days), and no RRT. The hazard ratios (HRs) and subdistribution HRs for RRT incidence were evaluated by cancer site (colon, lung, stomach, liver, kidney, esophagus, pancreas, and hematologic malignancies) using Cox proportional hazards and Fine-Gray competing-risk models adjusted for patient characteristics, comorbidities, and diuretic use. The 1-year cumulative incidence of RRT was also calculated.

A total of 230,850 patients were analyzed. Among them, 386 patients received RRT at ≤30 days after cancer treatment initiation (acute phase), 479 patients received RRT at >30 days (post-acute phase), and 229,985 patients did not receive RRT. In the Cox proportional hazards regression model, the HRs for RRT were significantly higher in the acute phase among patients with colorectal cancer (HR: 1.72, p < 0.001), liver cancer (HR: 1.80, p = 0.006), kidney cancer (HR: 2.49, p < 0.001), and hematologic malignancies (HR: 4.06, p < 0.001) when compared according to cancer site. In the post-acute phase, only hematologic malignancies showed a significantly increased HR for RRT (HR: 2.65, p < 0.001). The 1-year cumulative incidence of RRT among all patients was 0.413%.

The risk of RRT after cancer treatment was increased during the acute phase in patients with colorectal, liver, and kidney cancer and those with hematologic malignancies. Patients with hematologic malignancies always had a higher HR for RRT, but the HR was particularly high in the acute phase.