Acute kidney injury in cancer patients and impedance cardiography-assisted renal replacement therapy: Experience from the onconephrology unit of a Chinese tertiary hospital.

Acute kidney injury (AKI) in cancer patients may disrupt anticarcinogenic treatment and greatly increase associated mortality rates. The present study reported on the management of cancer patients with AKI and, from the nephrologic viewpoint, on the significance of fine volume control during the continuous renal replacement therapy (CRRT). The records of 117 cancer patients with AKI treated over three years were reviewed and their data were compared with those of 120 healthy controls. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria with serum creatinine levels determined on initial admission and for the diagnosis of AKI. CRRT with concomitant impedance cardiography (ICG) monitoring was performed in 79 patients. On average, AKI manifested as a 1.68±0.38-fold increase in serum creatinine within 10.2±5.7 days. The causes of AKI were diverse, with the major ones being nephrotoxic agents, hypotension and obstructive nephropathy. Renal biopsy confirmed two cases of thrombotic microangiopathy, due to the use of interfon-α and sunitinib malate, respectively, and a third case of cast nephropathy caused by immunoglobulin D multiple myeloma. The patients were generally marantic and had compromised cardiac function compared with the healthy controls. The CRRT prescription was discriminatingly optimized by the ICG parameters effecting discreet fluid balance, as the thoracic fluid content was significantly correlated with the ultrafiltration rate. By considering the causative mechanisms and applying subtle ICG-assisted volume control, the present study may thus help to improve the safety and efficacy of CRRT in cancer patients with AKI. In addition, it provided information to bring advances in onconephrology, a novel nephrological subspecialty field.