Gonadotropin-releasing hormone agonists and acute kidney injury in patients with prostate cancer.
BACKGROUND
Androgen deprivation therapy (ADT) might increase the risk of acute kidney injury (AKI) in patients with prostate cancer (PCa).


OBJECTIVE
To examine the impact of ADT on AKI in a large contemporary cohort of patients with nonmetastatic PCa representing the US population.


METHODS
Overall, 69 292 patients diagnosed with nonmetastatic PCa between 1995 and 2009 were abstracted from the Surveillance Epidemiology and End Results-Medicare database.
Patient in both treatment arms (ADT vs. no ADT) were matched using propensity-score methodology. Ten-year AKI rates were estimated. Competing-risks regression analyses tested the association between ADT and AKI, after adjusting for the risk of death during follow-up.


CONCLUSIONS
Overall, the 10-yr AKI rates were 24.9% versus 30.7% for ADT-naive patients versus those treated with ADT, respectively (p<0.001). When patients were stratified according to the type of ADT, the 10-yr AKI rates were 31.1% versus 26.0% for men treated with gonadotropin-releasing hormone (GnRH) agonists and bilateral orchiectomy, respectively (p<0.001). In multivariable analyses, the administration of GnRH agonists (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.18-1.31; p<0.001), but not bilateral orchiectomy (HR: 1.11; 95% CI, 0.96-1.29; p=0.1), was associated with the risk of experiencing AKI. Our study is limited by its retrospective design.


CONCLUSIONS
ADT is associated with an increased risk of AKI in patients with nonmetastatic PCa. In particular, the administration of GnRH agonists, but not surgical castration, may substantially increase the risk of experiencing AKI. These observations should help provide physicians with better patient selection to reduce the risk of AKI.


RESULTS
The administration of gonadotropin-releasing hormone agonists, but not bilateral orchiectomy, increases the risk of acute kidney injury (AKI) in patients with prostate cancer (PCa). These observations should help provide physicians with better patient selection to reduce the risk of AKI in PCa patients.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: giorgio.gandaglia@gmail.com.
Giorgio
G
Gandaglia
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
Maxine
M
Sun
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Jim C
JC
Hu
Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy.
Giacomo
G
Novara
Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Toni K
TK
Choueiri
Department of Radiation Oncology, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Paul L
PL
Nguyen
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
Jonas
J
Schiffmann
Martini-Klinik, University-Hospital Hamburg-Eppendorf, Hamburg, Germany.
Markus
M
Graefen
Department of Urology, Medical University of Vienna, Vienna, Austria.
Shahrokh F
SF
Shariat
Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy.
Firas
F
Abdollah
Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy.
Alberto
A
Briganti
Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy.
Francesco
F
Montorsi
Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Quoc-Dien
QD
Trinh
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
Pierre I
PI
Karakiewicz
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D015994:Incidence; D008297:Male; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D012044:Regression Analysis; D012189:Retrospective Studies; D020379:Risk Adjustment; D018426:SEER Program; D014481:United States / Q000453:epidemiology
D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone
Acute kidney injury; Androgen deprivation therapy; Competing risks; Prostate cancer; Renal failure; Side effects