The characteristics and risk factors for cisplatin-induced acute kidney injury in the elderly.
The characteristics and risk factors for cisplatin-induced acute kidney injury in the elderly.
复制标题
老年人顺铂所致急性肾损伤的特点及危险因素
DOI：
10.2147/tcrm.s165531
复制
发表时间：
2018
影响因子：
2.8
通讯作者：
Chen XM
中科院分区：
文献类型：
--
作者：
Liu JQ;Cai GY;Wang SY;Song YH;Xia YY;Liang S;Wang WL;Nie SS;Feng Z;Chen XM
目的顺铂最严重的不良反应是急性肾损伤(AKI)。顺铂所致的急性肾损伤(CIA)尚无专门的预防措施。本研究旨在探讨老年人CIA的特点和危险因素，并探讨降低CIA的可能方法。材料与方法选择2013年1月1日至2015年12月31日在同一中心就诊的≥患者，年龄18岁，接受顺铂初始化疗，治疗前、后2周内测定血肌酐，有完整病史。排除标准包括放射治疗或手术、肿瘤复发、以前接受顺铂治疗、在顺铂治疗前或治疗后缺乏任何Scr值、以及医疗记录不完整。结果527例患者中，老年患者349例。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)在老年患者中的使用率(9.2%)高于年轻患者(2.8%，P=0.007)。老年患者顺铂治疗剂量较低，但CIA发生率(9.46%)高于年轻患者(3.37%)。老年AKI组和非AKI组在Scr水平、估计肾小球滤过率、ACEI/ARB使用率以及是否单次应用顺铂方面存在显著差异。多因素分析显示，单一应用顺铂(OR 2.853，95%CI：1.229，6.621，p=0.015)和使用血管紧张素转换酶抑制剂/血管紧张素转换酶抑制剂(OR 3.398，95%CI：1.352，8.545，p=0.009)是老年人发生CIA的预测因素。结论老年患者CIA的发生率高于年轻患者。ACEI/ARB的使用和单用顺铂是老年人CIA的独立危险因素。
Objectives The most serious adverse reaction of cisplatin is acute kidney injury (AKI). Cisplatin-induced acute kidney injury (CIA) has no specific preventive measures. This study aims to explore the characteristics and risk factors for CIA in the elderly and to identify potential methods to reduce CIA. Materials and methods Patients ≥18 years old, with primary tumors, who received initial cisplatin chemotherapy and whose serum creatinine (SCr) values were measured within 2 weeks pre- and postcisplatin treatment and who had complete medical records, were selected from a single center from January 1, 2013 to December 31, 2015. The exclusion criteria included radiotherapy or surgery, recurrent tumors, previous cisplatin treatment, lack of any SCr values before or after cisplatin therapy, and incomplete medical records. Results Out of a total of 527 patients, 349 were elderly. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use (9.2%) was more prevalent in the elderly than in younger patients (2.8%, p = 0.007). The dosage of cisplatin treatment was lower in the elderly, but the incidence of CIA (9.46%) was higher in the elderly than in younger patients (3.37%). There were significant differences in the SCr levels, estimated glomerular filtration rate, ACEI/ARB use, and whether a single application of cisplatin was administered, between the elderly AKI group and the non-AKI group. Multivariable analysis showed that administration of a single application of cisplatin (OR 2.853, 95% CI: 1.229, 6.621, p = 0.015) and ACEI/ARB use (OR 3.398, 95% CI: 1.352, 8.545, p = 0.009) were predictive factors for developing CIA in the elderly. Conclusion The incidence of CIA in the elderly was higher than in younger patients. ACEI/ ARB usage and administration of a single application of cisplatin were independent risk factors for CIA in the elderly.