ADT use linked to higher risk of acute kidney injury

Use of androgen deprivation therapy was associated with a significantly increased risk of acute kidney injury, with variations observed with certain types of ADT, according to a recent study.

First author Francesco Lapi, PharmD, PhD, of Jewish General Hospital, Montreal, and colleagues conducted a study to determine whether the use of ADT was associated with an increased risk of acute kidney injury (AKI) in patients newly diagnosed with prostate cancer. The authors used medical information extracted from the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database. The study included men newly diagnosed with nonmetastatic prostate cancer between January 1997 and December 2008 who were followed up until December 2009.

Cases were patients with incident AKI during follow-up who were randomly matched with up to 20 controls on age, calendar year of prostate cancer diagnosis, and duration of follow-up. Analysis was conducted to estimate the odds ratios of AKI associated with the use of ADT. ADT was categorized into one of six mutually exclusive groups: gonadotropin-releasing hormone agonists, oral antiandrogens, combined androgen blockade, bilateral orchiectomy, estrogens, and combinations of the above.

A total of 10,250 patients met the study inclusion criteria. During follow-up, 232 cases with a first-ever AKI admission were identified. All cases were matched with at least one control. The authors found that compared with never use, current use of ADT was significantly associated with a 2.5 times increased odds of AKI.

“This association was mainly driven by a combined androgen blockade consisting of gonadotropin-releasing hormone agonists with oral antiandrogens, estrogens, other combination therapies, and gonadotropin-releasing hormone agonists,” the authors wrote in JAMA (2013; 310:289-96.)

“To our knowledge, this is the first population-based study to investigate the association between the use of ADT and the risk of AKI in men with prostate cancer. In this study, the use of ADT was associated with an increased risk of AKI, with variations observed with certain types of ADTs. This association remained continuously elevated, with the highest odds ratio observed in the first year of treatment. Overall, these results remained consistent after conducting several sensitivity analyses.

“These findings require replication in other carefully designed studies as well as further investigation of their clinical importance.”

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