Impact of Developing Dialysis-Requiring Acute Kidney Injury on Long-Term Mortality in Cancer Patients with Septic Shock

Simple Summary Although studies have evaluated the association between sepsis-related acute kidney injury and mortality, less is known about the epidemiology and course in cancer patients. This population-based cohort study using data from the Nation Health Insurance Service of Korea aimed to determine whether dialysis-requiring acute kidney injury could be related to an increase in short-term and long-term negative outcomes. All cancer patients admitted to a hospital via the emergency department with septic shock from 2009 to 2017 were included. Dialysis-requiring septic AKI occurred in 13% of adult cancer patients with septic shock and was associated with male sex, hematologic cancers, and comorbidities. Moreover, dialysis-requiring septic acute kidney injury was significantly associated with increased long-term mortality in the cancer patients, suggesting that the prevention of acute kidney injury, particularly in male hematologic cancer patients, should be emphasized. (1) Background: Considering recent advances in both cancer and sepsis management, we chose to evaluate the associated factors for occurrence of septic acute kidney injury in cancer patients using a nationwide population-based cohort data. (2) Methods: Using data from the National Health Insurance Service of Korea, adult cancer patients who presented to emergency departments with septic shock from 2009 to 2017 were analyzed. A Cox-proportional hazard model was conducted to evaluate the clinical effect of sepsis-related acute kidney injury requiring dialysis. (3) Results: Among 42,477 adult cancer patients with septic shock, dialysis-requiring acute kidney injury occurred in 5449 (12.8%). Recovery from dialysis within 30 days was 77.9% and, overall, 30-day and 2-year mortality rates were 52.1% and 85.1%, respectively. Oncologic patients with dialysis-requiring acute kidney injury frequently occurred in males and patients with hematologic cancer. A multivariate Cox-proportional hazard model showed that dialysis-requiring acute kidney injury had the highest adjusted hazard ratio of 1.353 (95% confidence interval 1.313-1.395) for 2-year mortality. (4) Conclusions: Dialysis-requiring septic acute kidney injury did not occur commonly. However, it had a significant association with increased long-term mortality, which suggests emphasis should be placed on the prevention of acute kidney injury, particularly in male hematologic cancer patients.

Automated summary

This study aimed to determine whether dialysis-requiring acute kidney injury in cancer patients could be related to an increase in short-term and long-term negative outcomes. The study found that dialysis-requiring septic acute kidney injury was associated with male sex, hematologic cancers, and comorbidities. It was also significantly associated with increased long-term mortality in cancer patients, suggesting the importance of prevention, especially in male hematologic cancer patients.