Predictors of early mortality after hemodialysis in patients with cancer and acute kidney injury

BackgroundDetermining when to initiate renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) can pose a considerable challenge, particularly for those with limited treatment options for cancer and a short life expectancy. This study aims to explore the predictors of short-term mortality among cancer patients undergoing hemodialysis following AKI.MethodsBetween January 2014 and April 2023, this retrospective study included 139 hospitalized patients with various cancers who underwent hemodialysis for AKI in Hacettepe University Oncology Hospital. Clinical and laboratory features, comorbidities, and survival outcomes were collected. Predictors of 30-day mortality after initiation of hemodialysis were evaluated.ResultsMedian age was 64 and 39% were females. ECOG performance score was 3-4 in 48%. Median Charlson comorbidity index was 8. Among the patients, 26% had gastrointestinal cancers and 23% had lung cancer. Notably, the etiology of AKI was prerenal-renal in 93% of the cases, with 45% of AKI instances occurring during hospitalization. 111 patients (80%) died within 30 days after the first hemodialysis session. In multivariate analysis, serum albumin less than 2.5 g/dl (OR: 3.14, 95% CI; 1.23-8.04, p=0.017), presence of sepsis (OR: 3.50, 95% CI; 1.34-9.10, p=0.010), prerenal-renal AKI (compared to postrenal AKI) (OR: 6.06, 95% CI 1.38-26.56, p=0.017) were associated with higher 30-day mortality. Patients with none of these risk factors had 33% 30-day mortality while those with all the identified risk factors had significantly higher rate of 93% (p<0.001).ConclusionsIn this study, patients with sepsis, pre-renal or renal AKI, and low albumin levels had higher early mortality rates after hemodialysis. Identifying AKI patients unlikely to benefit from RRT may assist clinicians in making informed decisions.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.