The characteristics and risk factors for cisplatin-induced acute kidney injury in the elderly

Figures & data

Figure 1 The flowchart of patient screening.

Table 1 Clinical characteristics of cancer patients who received cisplatin treatment

Characteristics	Total (n = 527)	Elderly (n = 349)	Nonelderly (n = 178)	p-value
Age (years)	61.71 ± 10.86	68.25 ± 3.97	48.90 ± 8.32	<0.001
Male n (%)	399 (75.7%)	276 (79.1%)	123 (69.1%)	0.011
ACEI/ARBs	37 (7.0%)	32 (9.2%)	5 (2.8%)	0.007
NSAIDs	20 (3.8%)	12 (3.4%)	8 (4.5%)	0.310
CKD	16 (3.0%)	14 (4.0%)	2 (1.1%)	0.104
Hypertension	122 (23.1%)	100 (28.7%)	22 (12.4%)	<0.001
DM	65 (12.3%)	56 (16.0%)	9 (5.1%)	0.001
Cardio-cerebrovascular disease	72 (13.7%)	67 (19.2%)	5 (2.8%)	<0.001
BMI (Kg/m^2)	23.64 ± 3.28	23.62 ± 3.30	23.70 ± 3.24	0.528
SBP (mmHg)	125.50 ± 13.25	126.63 ± 13.42	123.41 ± 13.67	<0.001
DBP (mmHg)	76.13 ± 7.52	75.94 ± 7.58	76.51 ± 7.41	0.732
Hb (g/L)	131.00 ± 19.02	130.95 ± 18.44	133.98 ± 19.13	0.027
SCr (µmol/L)	71.57 ± 15.13	73.20 ± 15.16	68.43 ± 14.60	<0.001
eGFR (mL/min)	92.37 ± 14.54	88.81 ± 10.33	99.74 ± 13.15	0.014
BUN (mmol/L)	4.77 ± 1.72	5.00 ± 1.73	4.32 ± 1.60	<0.001
SUA (µmol/L)	295.32 ± 90.23	292.98 ± 90.14	298.70 ± 89.22	0.478
Total protein (g/L)	66.75 ± 5.84	66.18 ± 6.05	67.85 ± 5.18	0.001
ALB (g/L)	39.11 ± 4.32	38.31 ± 4.14	40.69 ± 4.23	<0.001
Na (mmol/L)	142.00 (139.90, 143.06)	141.20 (138.70, 143.20)	141.90 (139.93, 143.38)	0.710
K (mmol/L)	4.12 ± 0.43	5.31 ± 0.49	4.13 ± 0.38	0.685
Mg (mmol/L)	0.90 ± 0.08	0.89 ± 0.08	0.89 ± 0.68	0.879
Cisplatin total dose (mg)	114.95 ± 25.57	112.42 ± 22.90	119.90 ± 24.17	0.001
Cisplatin mean dose (mg/m^2)	66.53 ± 13.16	64.32 ± 25.93	69.34 ± 11.22	<0.001
Cisplatin frequency				0.720
Single	329 (62.4%)	215 (61.6%)	114 (64.0%)
≥Two times	198 (37.6%)	134 (38.4%)	64 (36.0%)
Cisplatin application				0.408
I.V.	481 (91.3%)	316 (90.5%)	165 (92.7%)
Non-I.V.	46 (8.7%)	33 (9.5%)	13 (7.3%)
Hydration	491 (93.2%)	327 (93.7%)	164 (92.1%)	0.668
Volume of hydration (mL)	2,412.56 ± 846.08	2,432.01 ± 839.57	2,374.44 ± 859.79	0.305
Diuretics	341 (64.7%)	223 (63.9%)	118 (66.3%)	0.890
CIA	39 (7.4%)	33 (9.46%)	6 (3.37%)	0.012
Stage 1 CIA	32 (6.1%)	26 (7.5%)	6 (3.4%)	0.054
Stage 2 CIA	5 (0.9%)	5 (1.4%)	0
Stage 3 CIA	2 (0.4%)	2 (0.6%)	0

Note: p-value <0.05 was considered statistically significant.

Abbreviations: ACEI/ARBs, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers; BMI, body mass index; BUN, blood urea nitrogen; CKD, chronic kidney disease; DBP, diastolic blood pressure; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; I.V., intravenous injection; K, serum potassium; Mg, serum magnesium; Na, serum sodium; NSAIDs, nonsteroidal anti-inflammatory drugs; SCr, serum creatinine; SUA, serum uric acid; ALB, albumin; SBP, systolic blood pressure.

Table 2 Baseline clinical characteristics of cisplatin-induced AKI in the elderly

Characteristics	Elderly (n = 349)	AKI (n = 33)	Non-AKI (n = 316)	p-value
Age (years)	68.25 ± 3.97	67.45 ± 2.79	68.33 ± 4.07	0.109
Sex				0.345
Male	276 (79.1%)	24 (72.7%)	252 (79.7%)
Female	73 (20.9%)	9 (27.3%)	64 (20.3%)
BMI (mg/m^2)	23.62 ± 3.30	24.26 ± 3.64	23.54 ± 3.26	0.235
DM	56 (16%)	6 (18.2%)	50 (15.8%)	0.725
Hypertension	100 (28.7%)	12 (36.4%)	88 (27.8%)	0.303
CKD	14 (4.0%)	1 (3.0%)	13 (4.1%)	1.0
Cardio-cerebrovascular disease	67 (19.2%)	6 (18.2%)	61 (19.3%)	0.876
NSAIDs	12 (3.4%)	12 (3.8%)	0
ACEI/ARBs	32 (9.2%)	7 (21.2%)	25 (8.15%)	0.014
Hydration	327 (93.7%)	32 (97%)	29 (93.4%)	0.416
Volume of hydration (mL)	2,595.63 ± 571.35	2,550.0 ± 544.62	2,600.0 ± 574.85	0.696
Diuretics	223 (63.9%)	25 (75.8%)	198 (62.7%)	0.136
Cisplatin total dose (mg)	116.28 ± 20.67	115.76 ± 25.38	112.07 ± 26.00	0.325
Cisplatin mean dose (mg/m^2)	67.31 ± 10.57	67.14 ± 13.57	65.05 ± 13.73	0.145
Single-use cisplatin	215 (61.6%)	188 (59.5%)	27 (8.54%)	0.012
I.V. cisplatin	316 (90.5%)	31 (93.9%)	285 (90.2%)	0.484
SCr (µmol/L)	73.18 ± 15.16	74.02 ± 14.96	65.19 ± 14.99	0.001
eGFR (mL/min)	86.82 ± 12.11	86.24 ± 12.21	92.71 ± 12.31	0.002
Total protein (g/L)	66.18 ± 6.05	67.15 ± 5.69	66.08 ± 6.07	0.335
ALB (g/L)	38.31 ± 4.14	37.89 ± 4.15	38.35 ± 4.14	0.546
Na (mmol/L)	140.56 ± 4.42	139.42 ± 5.42	140.67 ± 4.31	0.052
K (mmol/L)	3.99 ± 0.51	3.94 ± 0.39	3.98 ± 0.52	0.661
Mg (mmol/L)	0.89 ± 0.08	0.88 ± 0.07	0.90 ± 0.08	0.126

Note: p-value <0.05 was considered statistically significant.

Abbreviations: ACEI/ARBs, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers; AKI, acute kidney injury; BMI, body mass index; CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; I.V., intravenous injection; K, serum potassium; Mg, serum magnesium; Na, serum sodium; NSAIDs, nonsteroidal anti-inflammatory drugs; SCr, serum creatinine; ALB, albumin.

Table 3 Risk factors for cisplatin-induced AKI in the elderly

Risk factors	Univariable analysis		Multivariable analysis
	OR (95% CI)	p-value	OR (95% CI)	p-value
Age (≥60 years)	0.943 (0.858, 1.037)	0.227	0.985 (0.883, 1.098)	0.785
Baseline eGFR	0.958 (0.932, 0.984)	1.065	0.975 (0.930, 1.023)	0.302
ACEI/ARBs use	3.340 (1.361, 8.192)	0.008	3.398 (1.352, 8.545)	0.009
Cisplatin single application	3.064 (1.230, 7.632)	0.016	2.853 (1.229, 6.621)	0.015

Note: p-value <0.05 was considered statistically significant.

Abbreviations: ACEI/ARBs, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers; AKI, acute kidney injury; eGFR, estimated glomerular filtration rate.