A couple of large, retrospective studies have suggested that there is some risk of ADT leading to acute kidney injury. Both studies, however, have been challenged because of potential confounding variables that the researchers did not explore. One study, for example, did not look at how long the patients were exposed to ADT. The other did not take into consideration the tumour stage for the patients in the study. The studies were thus inconclusive.
Tumour stage is of particular concern as tumors in the prostate gland can obstruct the urethra, making it difficult to empty the bladder and leading to potentially harmful back pressure on the kidneys. Thus, from what has been published so far it is not clear whether the incidence of kidney injury in patients with advanced prostate cancer is associated more with the treatment (i.e., ADT) or the disease itself.
Enter here a new study—a large retrospective study of over 10,000 men in the Scottish Cancer Registry. The men were all diagnosed with non-metastatic prostate cancer between 2012 and 2017. And they were matched with a cohort of cancer-free controls of the same age as the patients.
The authors adjusted their analysis to take into consideration both how long the men were on ADT and their tumour stage. Lo and behold, the prostate cancer patients had higher rates of acute kidney injury compared to the controls. The patients on ADT, however, did not have a higher rate of kidney injury versus the patients not on ADT. Although this confirms that prostate cancer is associated with a higher incidence of acute kidney disease, it doesn’t necessarily mean that prostate cancer caused the kidney injury. However, the study suggests that ADT is likely not a dominant factor in the incidence of acute kidney injury for prostate cancer patients treated with ADT.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/33772218/
References:
Cardwell CR, O'Sullivan JM, Jain S, Hicks BM, Devine PA, McMenamin ÚC. Hormone therapy use and the risk of acute kidney injury in patients with prostate cancer: a population-based cohort study. Prostate Cancer Prostatic Dis. 2021 Mar 26. doi: 10.1038/s41391-021-00348-x. Epub ahead of print. PMID: 33772218.
Daskivich, T.J. Androgen deprivation therapy and acute kidney injury in prostate cancer: room for debate?. Prostate Cancer Prostatic Dis (2021). https://doi.org/10.1038/s41391-021-00383-8. https://www.nature.com/articles/s41391-021-00383-8