Acute Kidney Injury and Renal Replacement Therapy in Oncology ICU

Abstract

Acute Kidney Injury (AKI) is one of the most important determinants of outcomes in hospitalised patients, more so in critically ill patients admitted in the intensive care unit (ICU). Critically ill cancer patients in the ICU with acute kidney injury often require renal replacement therapy, have longer length of hospital stay and are at a high risk for mortality. In addition to the standard risk factors like increasing age, comorbid illnesses, nephrotoxic drugs and infections, patients with malignancy are more susceptible to develop renal dysfunction either as a direct complication of the cancer or due to the use of chemotherapeutic drugs. Acute and chronic kidney diseases are more prevalent in patients with cancer and with remarkable advancements in the field of chemotherapy, immunotherapy and targeted therapies, there are increasing reports of hitherto unknown renal complications. A multi-disciplinary care team with coordinated efforts between the oncologist, nephrologist and intensivist is needed to improve outcomes for the patient. Recognising this link between cancer and kidney diseases and the increasing role of nephrologists in managing specific complications in cancer patients, a new subspecialty has been developed to provide the best nephrology care possible. This subspeciality, Onco-nephrology is expected to develop further in the future.