Kanser Hastalarında Akut Böbrek Hasarı Sonrası Yapılan Hemodiyalizin Morbidite ve Sağkalıma Etkisinin Belirlenmesi

Abstract

Gurbuz SC. Determination of the Effect of Hemodialysis on Morbidity and Survival After Acute Kidney Injury in Cancer Patients, Hacettepe University Faculty of Medicine, Thesis in Internal Medicine; Ankara, 2023. Acute kidney injury (AKI) is a sudden loss of renal function characterized by an increase in serum creatinine level and a decrease in urine output, leading to impaired fluid-electrolyte and acid-base balance. AKI, which is the most common renal pathology encountered in cancer patients, is an important cause of morbidity and mortality. As a result of innovations in the diagnosis and treatment process of cancer and developments in palliative care services, the survival time and quality of life of cancer patients have increased. Better life expectancy has also increased the likelihood of complications such as AKI. Hemodialysis is more commonly used in the treatment of AKI in cancer patients compared to the past. However, there is no defined criteria to guide the decision-making process on hemodialysis. Between January 2014 and April 2023, 139 patients diagnosed with cancer and receiving hemodialysis due to acute kidney injury, hospitalized in the inpatient services of Hacettepe University Faculty of Medicine Oncology Hospital were included in this study. Demographic data, hospitalization data, comorbidities, cancer-related data, laboratory values, cause and stages of acute kidney injury, hemodialysis process and survival data were evaluated. Patients were grouped as those who died within 30 days and those who lived longer than 30 days. In univariate analysis, serum albumin less than 2.5 g/dl (p=0.002), presence of sepsis (p<0.001), prerenal-renal AKI (p=0.005), admission to hemodialysis in intensive care unit (p= 0.02), hospital-acquired AKI (p=0.016), and low AKI stage at diagnosis (p=0.003) were associated with mortality in the first 30 days. In multivariate analysis, serum albumin less than 2.5 g/dl (OR: 3.14 (95% CI; 1.23-8.04), p=0.017), presence of sepsis (OR: 3.50 (95% CI; 1.34-9.10), p=0.010), prerenal-renal AKI (OR: 6.06 (95% CI 1.38-26.56), p=0.017) were associated with mortality in the first 30 days. A scoring system was created to predict mortality with these variables. When the two groups were compared based on the total scores obtained, the first 30-day mortality rate was higher in patients with higher scores. As a result, this study can contribute to determining which patients should receive hemodialysis, what the prognosis and mortality of these patients will be, in a joint decision-making process that facilitates the oncology and nephrology specialists to provide predictable information to patients and their relatives.