AKI in Cancer

An Oncologic Emergency

An estimated 2-12% of patients who receive high-dose methotrexate (HDMTX) chemotherapy will experience delayed clearance due to acute kidney injury (AKI), creating an oncologic emergency.1

Patients who survive an AKI episode have2:

  • Double the risk of death
  • Triple the risk of end-stage renal disease
  • Ten times the risk of developing incident or progressive chronic kidney disease

The rate of cardiovascular events in AKI patients is as high as 22%, and mortality related to cardiovascular events is 33% in patients with AKI.2

Inadequate Elimination of MTX Due to Impaired Renal Function Increases the Risk of Severe Toxicities3:

When renal dysfunction occurs and other toxicities are present, standard doses of leucovorin may no longer be an effective rescue intervention.4

 Grade 3-4 toxicities post-HDMTX in 43 patients with delayed MTX clearance due to impaired renal function3 
ToxicityPatients, n (%)
Hematological26 (60%)
Mucositis15 (35%)
Renal8 (19%)
Liver7 (16%)
CNS6 (14%)
Skin1 (2%)

Assessing the Risk of Acute Kidney Injury

There are many factors associated with MTX that can increase the risk of AKI, including1:

  • Dose and schedule of MTX
  • Preexisting renal insufficiency
  • Host factors including patient age and cancer type
 Types of tumors* associated with higher risk of AKI5-8 
Tumor typesIncidence of AKI
Osteosarcoma (N=3887)1.8%
Pediatric acute lymphoblastic leukemia (N=445)3.3%
Adult acute lymphoblastic leukemia (n=31)6.4%
Primary CNS lymphoma (n=154)3%-7%

*Tumor types included acute lymphoblastic leukemia, lymphoma, CNS lymphoma germ cell tumor, and osteosarcoma.

Renal Toxicity Is Common in Patients With Lymphoma and Leukemia

The incidence of renal toxicity in lymphoma and leukemia patients remains underappreciated. A 2014 retrospective analysis of lymphoma patients found that9:

  • Nearly 10% of lymphoma patients treated with HDMTX experienced renal toxicity
  • 31.9% of lymphoma patients experienced delayed MTX elimination
  • Renal toxicity resulted in significantly longer hospital stays

Comparison of incidence of HDMTX-mediated renal toxicity and delayed MTX elimination in patients with lymphoma9

Trust Voraxaze® for Rapid, Nonrenal Elimination of MTX4

It may not be possible to predict who will experience kidney injury or failure during HDMTX treatment. Only Voraxaze® reduced plasma MTX levels by >97% within 15 minutes.10