Cohort Study: Validation of a risk score for severe acute kidney injury in cisplatin treatment

Study Design and Population:
This multicenter cohort study aimed to develop and validate a risk prediction model for severe cisplatin-associated acute kidney injury (CP-AKI). Conducted across six major academic cancer centers in the U.S., it included 24,717 adult participants (≥18 years) who received their first dose of intravenous cisplatin from 2006 to 2022. The study population was split into a derivation cohort of 11,766 and a validation cohort of 12,951.

Main Findings:
The study reported an incidence of CP-AKI of 5.2% in the derivation cohort and 3.3% in the validation cohort. Factors independently associated with CP-AKI included age, hypertension, diabetes, and baseline serum levels of creatinine, magnesium, and other relevant biomarkers. A novel, simple risk score was developed using nine covariates, demonstrating significant predictive capability for CP-AKI. The highest risk category had up to 24.00-fold increased odds of CP-AKI compared to the lowest risk category, with the primary model showing superior discrimination (C statistic 0.75) over previous models.

Implications for Practice:
The validated risk score offers a practical tool for clinicians to estimate the risk of severe CP-AKI in patients undergoing cisplatin chemotherapy. Its use could enhance monitoring strategies and potentially guide therapeutic decision-making to mitigate the risk of kidney injury and associated mortality.

Reference (free full-text):
Gupta et al. (2024). Derivation and external validation of a simple risk score for predicting severe acute kidney injury after intravenous cisplatin: cohort study. BMJ, 384, e077169. DOI: https://doi.org/10.1136/bmj-2023-077169