Gonadotropin-releasing Hormone Agonists and Acute Kidney Injury in Patients with Prostate Cancer

医学 雄激素剥夺疗法 危险系数 前列腺癌 急性肾损伤 内科学 泌尿科 睾丸切除术 回顾性队列研究 队列 比例危险模型 置信区间 肿瘤科 癌症
作者
Giorgio Gandaglia,Maxine Sun,Jim C. Hu,Giacomo Novara,Toni K. Choueiri,Paul L. Nguyen,Jonas Schiffmann,Markus Graefen,Shahrokh F. Shariat,Firas Abdollah,Alberto Briganti,Francesco Montorsi,Quoc‐Dien Trinh,Pierre I. Karakiewicz
出处
期刊:European Urology [Elsevier BV]
卷期号:66 (6): 1125-1132 被引量:36
标识
DOI:10.1016/j.eururo.2014.01.026
摘要

Androgen deprivation therapy (ADT) might increase the risk of acute kidney injury (AKI) in patients with prostate cancer (PCa). To examine the impact of ADT on AKI in a large contemporary cohort of patients with nonmetastatic PCa representing the US population. 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. 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. 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. 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.
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