Report of sequential interventions at a tertiary cancer centre to reduce acute kidney injury rates following concurrent cisplatin with radiotherapy for head and neck cancer
Portner, Robin Gaito, Simona Garcez, Kate Lee, Lip W Mais, Kathleen L Price, James Sykes, Andrew J Thomson, David J McPartlin, Andrew J
Portner, Robin
Gaito, Simona
Garcez, Kate
Lee, Lip W
Mais, Kathleen L
Price, James
Sykes, Andrew J
Thomson, David J
McPartlin, Andrew J
Citations
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Abstract
Introduction: Standard of care Cisplatin chemoradiation (CRT) for
head and neck cancer cancers (HNC) improves outcomes, but has
associated risk of acute kidney injury (AKI). Various interventions have
been proposed to reduce this risk. We report the effects of sequential
changes in practice at a tertiary oncology centre introduced to reduce
the incidence of AKI and reviewed in a repeated assessment cycle.
Materials and Methods: AKI rates was assessed for three patient
cohorts receiving concurrent cisplatin with radiotherapy from April
2016 to February 2020. AKI Stage 1 was defined as a rise in creatinine
more than 1.5 times baseline or >26 umol/l in 48 hr, Stage 2 as doubled
and Stage 3 as triple baseline creatinine. All patients received cisplatin
100 mg/m2 in 1L NaCL on D1 and D22 of a six week radiotherapy
course. This was given overnight with 1L Nacl pre-hydration and 2L
NaCl post cisplatin administration. Initially patients had a baseline
nuclear medicine GFR (if <60 ml/min cisplatin was omitted) and then
renal function checked prior to cycle 2 cisplatin, unless concerns about
fluid intake. From cohort 2 all patients were mandated to undergo
weekly blood tests during treatment regardless of symptoms or oral
intake and a pre-chemotherapy review was initiated including
recording of stopping all nephrotoxic medications prior to treatment.
For cohort 3 mannitol 10% 120 ml added to the chemotherapy regime
which otherwise remained unchanged.
Results: A total of 136, 39 and 50 patients were audited in cohort 1,2
and 3 respectively. Patient and disease characteristics were well
matched in each group. The number of patients suffering any AKI
during treatment fell from 38% to 26% over the period, despite
increased frequency of monitoring. AKI stage I fell from 27% to 18% and
severe AKI stage III incidence fell from 5% to 0%. Admission rates for
management of AKI dropped by almost two thirds, from 34% to 18%,
and then 12% in each successive cohort.
Conclusions: This study has demonstrated that the sequential
adoption of simple evidence based interventions to reduce the
incidence of AKI during CTRT with cisplatin can have a significant
benefit to patient outcomes, reducing treatment related nephrotoxicity and requirement for inpatient management. Despite
this one in four patients continues to suffer AKI during therapy
highlighting the need for meticulous management of this patient group.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Portner R, Gaito S, Garcez K, Lee L, Mais K, Price J, et al. Report of sequential interventions at a tertiary cancer centre to reduce acute kidney injury rates following concurrent cisplatin with radiotherapy for head and neck cancer. Oral Oncology. 2021;118.