Consensus Report from Oncology Advisory Board Meeting

Burden of Nephrotoxicity Acute kidney injury (AKI) is a common disorder in hospital settings and the most common cause of AKI is sepsis. However, causes like cardiorenal syndrome are taking over, with oncologic causes becoming an important component of AKI pathogenesis. Among the mechanisms of AKI, most are either ischemic, inflammatory or toxic. Renal toxicity by contrast media (CM) represents an important cause of AKI. It is important to increase awareness about this contrast induced AKI (CI-AKI) to homogenize the terminology and definition of CI-AKI as well as to develop best practices protocol and mitigate the damage induced by CM. Terminology of CI-AKI RIFLE Criteria for AKI Variability in the definitions of CI-AKI have important consequences in terms of resource allocation (determining estimates of the incidence, costs, and outcomes of AKI), the timing of consultation and the methodology and comparability of clinical trials. Therefore, in 2004, the Acute Dialysis Quality Initiative (ADQI) sought a consensus definition that: y y Clearly established the presence or absence of the disease, y y Gave an idea of the severity of the disease, y y Correlated disease severity with outcome, and y y Was easy to understand and applicable in a variety of clinical and research settings. The result was the Risk, Injury, Failure, Loss, End-stage renal disease (RIFLE) classification (Fig. 1). Acute kidney injury network (AKIN) in 2007, led an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Acute kidney injury network proposed a modification to this system, i.e., RIFLE classification, to consider the evidence that lower serum creatinine (Cr) changes might be associated with adverse outcomes and allow patients to be staged. AKIN Nephrologists’ Viewpoint on Recent Advances in CI-AKI As per the literature and recent guidelines, it is sufficient to label a patient as AKI once there is an absolute increase of 0.3 mg/dL in serum Cr value or 1.5 times increase in Cr value from the baseline within 48 hours of injecting the contrast. Clinicians should use consistent criteria to diagnose and classify AKI, based on the latest guidelines. Fig. 1. RIFLE: Risk, Injury, Failure, Loss, ESRD. ARF: acute renal failure; Cr: creatinine; ESRD: end-stage renal disease; UO: urinary output Source: Figure adapted from Bellomo R, et al . Crit Care. 2004; 8: R204–R212. JB 6810 01-2016 AKI in cancerpatients RIFLE: Risk, Injury, Failure, Loss, ESRD Figure adapted from Bellomo R et al. Crit Care 2004; 8 : R204 – R212. AR : acute renal failure Cr: creatinine ESRD: end-stage renal disease UO: urinary output CR/GFR criteria UO criteria Cr increased × 1.5 or GFR decreased >25% UO <0.5 ml/kg/hour for 6 hours Cr increased × 2 or GFR decreased >50% UO <0.5 ml/kg/hour for 12 hours Cr increased × 3 or GFR decreased >75% or Cr ≥4 mg/dl (with acute rise of ≥0.5 mg/dl) UO <0.3 ml/kg/hour for 24 hours or Anuria for 12 hours Persistent ARF: complete loss of renal function for >4 weeks End-stage renal disease Risk Injury Failure Loss ESRD