Abstract
OBJECTIVE: To systematically investigate the clinical characteristics, peri-chemotherapy changes in renal function, and independent risk factors associated with chemotherapy-related renal injury (CRI) in patients with malignant tumors, providing scientific basis for developing individualized prevention and intervention strategies. METHODS: A retrospective study design was adopted. A total of 152 patients with malignant tumors who underwent chemotherapy in the Department of Oncology of our hospital from January 2020 to December 2023 were included. Patients were categorized into a chemotherapy-related renal injury (CRI) group (n = 28) and a non-CRI group (n = 124) based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. CRI was defined as a composite endpoint comprising either acute kidney injury (AKI) occurring within 1 week after the first chemotherapy cycle, or chronic kidney disease (CKD) persisting for more than 3 months post-chemotherapy. Renal function was assessed at standardized time points: within 1 week after cycle 1 and at the 3-month follow-up. The timing of post-chemotherapy renal function assessment was standardized for all patients, with the first evaluation conducted within 1 week following the completion of the first chemotherapy cycle (to capture AKI events) and a second evaluation performed at the 3-month follow-up visit (to assess CKD persistence). Patient demographics (age, gender, BMI, etc.), comorbidities (hypertension, diabetes, chronic kidney disease, etc.), tumor-related information (type, stage), chemotherapy regimens (use of nephrotoxic drugs, number of drugs), and renal function indicators before and after chemotherapy [serum creatinine (SCr), blood urea nitrogen (BUN), uric acid (UA), estimated glomerular filtration rate (eGFR)] were collected from the hospital electronic medical record system. Univariate analysis screened CRI-associated factors, followed by multivariate logistic regression to identify independent risk factors. RESULTS: Among 152 patients undergoing chemotherapy for malignant tumors, the CRI incidence was 18.42% (28/152). The CRI group had a significantly higher proportion of patients aged ≥ 60 years, as well as higher rates of hypertension, diabetes, chronic kidney disease, use of nephrotoxic agents, and receipt of ≥ 3 chemotherapy drugs. in the CRI group than in the non-CRI group (all P < 0.05). Post-chemotherapy, the CRI group exhibited significantly elevated SCr, BUN, and UA levels and significantly reduced eGFR levels compared with the non-CRI group (all P < 0.001). Multivariate logistic regression analysis confirmed that age ≥ 60 years (OR = 3.277, 95% CI: 1.175–9.134, P = 0.023), concurrent diabetes (OR = 4.544, 95% CI: 1.612–12.809, P = 0.004), history of chronic kidney disease (OR = 6.348, 95% CI: 1.100–36.638, P = 0.039), use of nephrotoxic chemotherapy drugs (OR = 3.930, 95% CI: 1.143–13.511, P = 0.030), and increased number of chemotherapy drugs (OR = 2.068, 95% CI: 1.185–3.612, P = 0.011) were factors independently associated with CRI occurrence. CONCLUSION: This study identifies a relatively high incidence of CRI among patients with malignant tumors undergoing chemotherapy. The findings suggest that age ≥ 60 years, diabetes, chronic kidney disease, use of nephrotoxic agents, and an increased number of chemotherapy drugs are associated with higher risk of CRI. However, due to the retrospective design and limited number of CRI events, these findings should be interpreted with caution. Further prospective studies with larger sample sizes are needed to validate these associations. These associations highlight the need for enhanced renal function monitoring and cautious selection of chemotherapy regimens, particularly in high-risk populations.