Abstract: FR-PO247
Association Between Cancer and AKI Among Medicare Fee-for-Service Beneficiaries, 2006-2014
Session Information
- Onconephrology: From AKI to CKD and Everything in Between
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Miyamoto, Yoshihisa, National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation, Atlanta, Georgia, United States
- Andes, Linda J., National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation, Atlanta, Georgia, United States
- Koyama, Alain K., National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation, Atlanta, Georgia, United States
- Xu, Fang, National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation, Atlanta, Georgia, United States
- Pavkov, Meda E., National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation, Atlanta, Georgia, United States
Background
Acute kidney injury (AKI) is a heterogeneous syndrome characterized by an abrupt decline in kidney function. Although patients with cancer are likely to be susceptible to AKI, population-based incidence of AKI in patients with cancer is not well understood in the US.
Methods
We conducted a population-based retrospective cohort study among Medicare fee-for-service beneficiaries who were continuously enrolled for six-years, including an initial one year cancer-free window before the index year. The index year was defined by a new cancer diagnosis. Follow-up started with the index year and ended at the time of AKI, death, or censoring at the end of five years. We defined incident cancer by the presence of two ICD-9 CM diagnosis codes in an outpatient setting or one ICD-9 CM inpatient code. A control group without cancer represented patients without any cancer diagnoses over the same time period, matched on age, sex, and race and ethnicity. The main outcome was time to AKI or death. All-cause death date was ascertained using the National Death Index. Association between cancer and AKI was assessed by cause-specific hazard and Fine-Gray competing risk models.
Results
We identified 5,613,285 Medicare fee-for-service beneficiaries with incident cancer and the same number of matched controls. Beneficiaries with cancer were at greater risk of AKI (unadjusted hazard ratio [HR]=1.66) and death (HR=2.83). The associations were significant after adjustment for covariates (HR=1.38 and HR=2.53, respectively). When death was modeled as a competing risk, unadjusted subdistribution hazard ratio (SHR) of AKI in patients with vs. without cancer was 1.20, and the adjusted SHR was 0.98. All outcomes were significant due to the large sample size.
Conclusion
Medicare fee-for-service beneficiaries with cancer were at greater risk of AKI, compared with those without cancer. However, because the cause-specific association of cancer with death was stronger than that with AKI, impact of cancer on cumulative incidence of AKI indicated by SHR was not notable.
Funding
- Other U.S. Government Support