Listed among the rare side effects of ADT is acute kidney injury (AKI). One does not hear much about that though, presumable because it is rare. But what is behind that risk? Is it rare–like some rare allergic reactions, which some people never experience, but for others are life threatening?
There is now a review by a urologist in Japan on how ADT might lead to impaired kidney function. This paper helps demystify the risk of AKI.
AKI is an extreme form of renal impairment and, as the author points out, some level of renal impairment can occur with dyslipidemia. So, what is dyslipidemia? Dyslipidemia is an unhealthy level of the triglycerides and high- and low-density cholesterol in one's blood. Dyslipidemia is associated with diabetes and is part of the type of metabolic syndrome that has been associated with ADT, and the elevated risk of diabetes for men on ADT.
We often talk about how ADT, if not properly managed, can increase the risk of diabetes. In the same way that a poor lipid profile puts men at risk of diabetes, it can increase the risk of renal impairment. This doesn't get discussed often because it typically goes unnoticed…unless it is severe and presents itself as AKI and, in the extreme, as kidney failure.
For the same reason that we need a good lifestyle to avoid the risk of diabetes when on ADT, the same precautions can help avoid renal impairment. Another way to view this is that patients on ADT should maintain a lifestyle that avoids dyslipidemia, not only because of the risk of cardiovascular disease and diabetes, but also because it helps preserve good kidney function.
The author ends with simple recommendation about language and we think it is a good one. There he states: “With regard to lipid dysfunction due to ADT, the term ‘renal impairment’ should be used instead of ‘AKI’”.
Reference:
Masuda, H. (2023). Renal Impairment: A Major Adverse Event in Prostate Cancer Patients Treated With Androgen Deprivation Therapy. Anticancer Research, 43(1), 305-309.