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Kidney Injury and Androgen Deprivation Therapy

Summary and Comment |
July 19, 2013

Kidney Injury and Androgen Deprivation Therapy

  1. Robert Dreicer, MD, MS, FACPAU1254

Among men with nonmetastatic prostate cancer, ADT was associated with excess risk for acute kidney injury.

  1. Robert Dreicer, MD, MS, FACPAU1254

Androgen deprivation therapy (ADT) for nonmetastatic prostate cancer, though somewhat common, remains controversial, given both the lack of level-1 evidence to support its routine use and the associated risks for adverse effects, including metabolic syndrome, osteoporosis, and impact on libido. Considering that ADT may also have a negative impact on renal function, as a result of treatment-induced testosterone suppression and its downstream consequences, investigators sought to determine the potential impact of ADT on the risk for acute kidney injury (AKI).

The researchers conducted a retrospective, nested, case-control analysis involving 10,250 men (age, ≥40) with nonmetastatic prostate cancer diagnosed from 1998 through 2008, with follow-up through 2009, and no history of metastatic disease or serious renal or liver disease. Patients were selected from the robust United Kingdom Clinical Practice Research Datalink in combination with the Hospital Episodes Statistics database. A total of 232 cases with first-ever AKI admission (incidence rate, 5.5 per 1000 person-years) were identified and matched with 2721 controls without AKI. ADTs were categorized as gonadotropin-releasing hormone agonists, oral antiandrogens, combined androgen blockade, bilateral orchiectomy, estrogens, or combinations of these treatments. ADT exposure was categorized as current use, past use, or never use.

Current use of any ADT significantly increased risk for AKI versus never use (OR, 2.48; 95% confidence interval, 1.61–3.82), generating a rate difference of 4.43 per 1000 persons per year (95% CI, 1.54–7.33). Past use did not significantly increase risk for AKI versus never use (OR, 1.25; 95% CI, 0.68–2.29).

Comment

Although provocative, these findings remain hypothesis-generating, and given that no prior study has addressed this issue, they must be replicated in other settings. Our current understanding of the risks associated with androgen deprivation therapy should preclude its routine use in patients with prostate-specific antigen (PSA)-only disease, especially in those with prolonged PSA doubling times.

  • Disclosures for Robert Dreicer, MD, MS, FACP at time of publication Consultant / Advisory board Dendreon; Eli-Lilly; Endo Pharmaceuticals; Ferring; Janssen; Millennium; Novartis Speaker's bureau Janssen Editorial boards Urology Leadership positions in professional societies National Cancer Institute (Co-Chair, GU Oncology Steering Committee)

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