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AKI in critically ill cancer patients: do we need more studies? : No !

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Presentation on theme: "AKI in critically ill cancer patients: do we need more studies? : No !"— Presentation transcript:

1 AKI in critically ill cancer patients: do we need more studies? : No !
Michaël DARMON Medical-Surgical ICU Saint-Etienne University Hospital Saint-Etienne , France

2 Conflict of interests Research grants: MSD
Research support: Astute Medical Speaker Fees : MSD, Astellas, Bristol-Myers Squibb Grant to organize educational meetings: MSD, Astellas, Jazz Pharmaceutical Advisory board: Sanofi

3 Conflict of interests

4 Conflict of interests THESE ARE FAKE NEWS !

5 Framework More research dedicated to AKI in critically-ill cancer patients? Are any the potential objectives specific ? Research agenda regarding AKI in the next decade Conclusion

6 Framework More research dedicated to AKI in critically-ill cancer patients? Are any the potential objectives specific ? Research agenda regarding AKI in the next decade Conclusion

7 What do we know Acute Kidney Injury in CICP is frequent

8 Darmon et al. Nephrol Dial Transplant 2015

9 Prevalence and consequences of AKI
Schetz et al. Intensive Care Med 2015 9

10 What do we know Acute Kidney Injury in CICP is frequent
Risk factors of AKI in this setting are the same than in general ICU population

11 Prevalence in the studied population
Risk factors of AKI Nisula et al. Soares et al. Darmon et al. Sepsis Shock / severity Shock/hypovolemia Shock Nephrotoxic agents Older age Cardiac arrest Tumor lysis syndrome Rhabdomyolysis Myeloma Diuretics (?) Comorbidities Prevalence in the studied population Myeloma : 3 to 12% TLS: 3 to 9% Nisula et al. Intensive Care Med 2013 Soares et al. J Clin Oncol 2006 Darmon et al. Nephrol Dial Transplant 2015

12 What do we know Acute Kidney Injury in CICP is frequent
Risk factors of AKI in this setting are the same than in general ICU population AKI in CICP is associated with grim short term prognosis

13 Prevalence and consequences of AKI
Nisula et al. Intensive Care Med 2013 Darmon et al. Nephrol Dial Transplant 2015 13

14 What do we know Acute Kidney Injury in CICP is frequent
Risk factors of AKI in this setting are the same than in general ICU population AKI in CICP is associated with grim short term prognosis AKI in CICP is associated with morbidity and long term outcome

15

16 Risk of hospital readmission
Multicentre data registry – Boston – 62,096 Critically-ill patients Admission Adjusted risk of readmission (OR; 95%CI) R class AKI: 1.39 (95%CI ) I class AKI: 1.47 (95%CI ) F class AKI: (95%CI ) Horkan et al. Crit Care Med 2015 16

17 728 progressors toward CKD stage 4 (13.6%)
Chronic renal dysfunction following AKI 5351 Patients with AKI (ICD 9 definition - 15,917 controls) 728 progressors toward CKD stage 4 (13.6%) Chawla et al. Kidney international 2012 17

18 10-years survival in AKI patients: 28%
Long-term mortality following AKI Single centre cohort study ICU Patients AKI defined according to the serum creatinine criteria of KDIGO classification 10-years survival in AKI patients: 28% Overall mortality Mortality in day-28 survivors Linder et al. Am J Respir Crit Care Med 2014 18

19 Framework More research dedicated to AKI in critically-ill cancer patients? Potential objectives of research in field of AKI Research agenda on AKI for the next decade Conclusion

20 Research on AKI specific to CICP?
Identification of high risk patients (TLS at the era of targeted th.) Early detection / diagnosis of AKI (High grade malignancy) Reshaping the diagnostic tree of AKI (Specific diagnosis of AKI) Preventing / mitigating renal injury (TLS, Cast nephropathy) Optimal management (optimal timing of RRT in TLS patients) Mitigating long term consequences of AKI Renal reserve (Allogeneic stem cell transplantation) Renal function (Allo-SCT, long term renal function, risk of CKD…) Other organs (including remission)

21 Framework More research dedicated to AKI in critically-ill cancer patients? Potential objectives of research in field of AKI Research agenda on AKI for the next decade Conclusion

22

23 Framework More research dedicated to AKI in critically-ill cancer patients? Are any the potential objectives specific ? Research agenda regarding AKI in the next decade Conclusion

24 Conclusion A lot remain to be done to improve outcome of AKI patients
Cancer patients is a subgroup with few specificities Research purposes are similar to the general ICU population Next steps ? Large studies (observational / RCTs) with preplanned stratification Research on diseases/syndromes: TLS, Myeloma, sepsis, rhabdomyolysis… Meanwhile: advocating early ICU admission of high risk patients

25 Thank you for your attention

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