Androgen Deprivation Therapy Linked to AKI Risk

Men with prostate cancer undergoing androgen deprivation therapy (ADT) may be at increased risk for acute kidney injury (AKI), according to a report in the Journal of the American Medical Association.

British general practice and hospital databases were used to identify 10,250 men with newly diagnosed, nonmetastatic prostate cancer. Patients with incident AKI were matched with as many as 20 control individuals. The association between receipt of ADT—classified as gonadotropin-releasing hormone agonists, oral antiandrogens, combined androgen blockade, bilateral orchiectomy, estrogens, or a combination of these—and the occurrence of AKI was assessed.

A total of 232 incident cases of AKI occurred during a mean follow-up time of 4.1 years, for a rate of 5.5 cases per 1000 person-years. Current ADT users were at increased risk for AKI, compared with those who never received ADT: odds ratio (OR) 2.48. The difference in incidence associated with AKI was 4.43 per 1000 persons per year. With adjustment for all potential confounders, the OR was 2.68.

The ADT-associated increase in risk mainly reflected the use of combined androgen blockade with gonadotropin-releasing hormone agonists plus oral antiandrogens (OR 4.50), estrogens (OR 4.00), other ADT combinations (OR 4.04), and gonadotropin-releasing hormone agonists (OR 1.93). The association weakened after the first year of ADT use but remained significant at longer follow-up times.

Androgen deprivation therapy can delay progression in men with advanced prostate cancer. However, ADT-induced testosterone suppression may adversely affect renal function.

This study found an increased rate of AKI among men with nonmetastatic prostate cancer receiving various types of ADT, with evidence of a possible additive effect. The authors call for further studies to confirm the association between AKI and ADT and to determine its clinical significance [Lapi F, et al. Androgen deprivation therapy and risk of acute kidney injury in patients with prostate cancer. JAMA 2012; 310:289–296].