Clinical Analysis Of Drug-induced Kidney Injury In Antineoplastic Drugs

Objective: Drug-induced kidney injury is one of the most common complications of drugs. Without timely treatment, it will lead to irreversible renal damage. Lacking of specific serological markers for the diagnosis of renal injury, drug-induced kidney injury can often be overlooked or misdiagnosed.Antineoplastic drugs may lead to some common side effects, such as nausea and vomiting, bone marrow suppression, which can also cause damage to kidney in varying degrees. As one of the most effective drugs in the treatment of lung cancer, platinum containing drugs bring about strong nephrotoxicity.The aim of this study is to investigate the high risk of renal injury in patients with lung cancer after chemotherapy, and to further explore the effect of different kinds of platinum drugs and chemotherapy cycle on renal function. To find the correlation between platinum drugs and drug-induced renal injury and the prognostic risk factors, in order to make instruction to the usage of drugs and to ensure the renal safety.Method: 1. Retrospective analysis on clinical data of 513 patients with lung cancer from June 2015 to July 2016 treated in our hospital. Ended with the last discharge or the last follow-up. According to the criteria of drug-induced renal damage, through the laboratory data of patients (urea, Scr, Ccr, etc.), patients were divided into two groups:drug-induced renal injury group, no drug-induced kidney injury group. Clinical data include age, gender, underlying diseases, BMI, basic Ccr, chemotherapy drugs and chemotherapy cycles. Aim o find the relationship between the two groups and to find the risk factor of kidney injury after chemotherapy; 2. According to the outcome, 513 patients were divided into three groups: cured, improved, not cured. To find the relationship between the prognosis with age, gender, whether combined with basic diseases, BMI, basic Ccr, urine abnormalities, changes of creatinine, in order to find risk factors.And further analysis on not cured patients.Results: 1.345 patients are males and 168 are females among 513 patients. The average age was 57.19 ± 9.86 years old. The incidence of drug-induced renal injury was 24.17%; 2.Age,combined with hypertension or diabetes,BMI,basic Ccr is the risk factor to develop kidney damage after the exposure to platinum chemotherapy(P<0.05);3.The incidence of renal injury after the usage of cisplatin chemotherapy was significantly higher than that of in carboplatin group (26.84% vs 18.96%),while there was no significant difference between different chemotherapy regimens (P>0.05);4.The renal toxicity was significantly increased after 4 cycles using of cisplatin and carboplatin(P>0.05);5.Mean onset time was 33.62 ± 45.34 days,range 2 days to 210 days.Gender,age difference in the onset time was not statistically significant (P>0.05).Patients with hypertension or diabetes and lower BMI has significantly difference(P<0.05);6.In the aspect of recovery time, the average was 36.19 + 44.76 days,range 3 days to 210 days(P<0.05). Patients with age ?60,combined with hypertension or diabetes,lower BMI need longer time for recovery(P<0.05);7.Among all patients with renal injury,77(62.10%) recovered and 31(25%) improved(P<0.05).Patients with age?60,combined with basic diseases,lower BMI,urine abnormalities,creatine changes higher than 2 times,basic Ccr between < 80ml/min have poor prognosis,P<0.05.Conclusion: 1 .Patients with age ?60, combined with hypertension or diabetes, lower BMI have high incidence of renal injury after using platinum drugs; 2.The nephrotoxicity of carboplatin was significantly lower than that of cisplatin. The renal toxicity of the two drugs was significantly increased after 4 cycles chemotherapy; 3.Patients with age ?60,combined with hypertension or diabetes, lower BMI needs longer time to recover ; 4.The majority can be reversed after renal injury, while others become irreversible.Those patients are mostly aged, combined with basic diseases, lower BMI and Ccr, cisplatin dose higher than 70mg/m2; 5.Patients with age ?60, combined with hypertension or diabetes, lower BMI, urine abnormalities, creatine changes higher than 2 times,basic Ccr< 80ml/min have poor prognosis. For those patients, even received early clinical intervention, it can also lead to irreversible renal injury.