Androgen deprivation therapy increases risk of kidney injury in prostate cancer patients

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1. Androgen deprivation therapy increases the risk of acute kidney injury in patients with non-metastatic prostate cancer. 

2. Past use of androgen deprivation therapy did not significantly increase the risk of acute kidney injury. 

Evidence Rating Level: 3 (Average) 

Study Rundown: Androgen deprivation therapy (ADT) effectively creates a hypogonadal state for the patient being treated. The motivations for the study stemmed from the increasing use of ADT for patients with non-metastatic prostate cancers and the postulated protective effects estrogen and testosterone may play on peripheral circulation and renal glomerular function. This study found that ADT, in the form of androgen blockage, estrogen, gonadotropin releasing hormone (GnRH agonists), and other combined therapies, increased the risk of acute kidney injury (AKI) in patients being treated for non-metastatic prostate cancer. While more research is needed to solidify the causation of AKI in the setting of ADT, this analysis presents a solid foundation upon which future research can build. Also, this study may impact the prescription of ADT for patients without metastatic prostate cancer and will likely spur dialogue concerning effects of hormonal treatments.

Click to read the study, published today in JAMA

Relevant Reading: Estrogen Protects renal endothelial barrier function from ischemia-reperfusion in vitro and in vivo

In-Depth [nested case-control analysis]: This study analyzed data of 232 patients diagnosed with and treated with ADT for non-metastatic prostate cancer who developed AKI from the United Kingdom Clinical Practice Research Datalink (CPRD). It was found that compared to no therapy, current use of ADT increased the risk of AKI (OR, 2.68 CI95%[1.81-3.98]. Current ADT use also yielded an increased incidence of AKI at 4.43 per 1000 persons per year (CI95% 1.54-7.33). Interestingly past use of ADT did not significantly increase risk of AKI (OR, 1.20 CI95%[0.68-2.10]). Analysis was also conducted based on the type of ADT used. Combined androgen blockade (OR, 4.50 CI95%[2.61-7.78]), estrogen only (OR, 4.00 CI95% [1.06-15.03]), GnRH agonists (OR,1.93 CI95%[1.20-3.10]), and other combination therapies (OR, 4.04 CI95%[1,88-8.69]) therapies were also individually found to increase the risk of AKI.

By Ravi Shah and Brittany Hasty

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