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Association between adjuvant chemotherapy and risk of acute kidney injury in elderly women diagnosed with early-stage breast cancer

Breast Cancer Research and Treatment volume 161, pages 515–524 (2017)Cite this article

Abstract

Purpose

We studied elderly Medicare enrollees newly diagnosed with early-stage breast cancer to examine the association between adjuvant chemotherapy and acute kidney injury (AKI).

Methods

Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort study including women diagnosed with stages I–III breast cancer at ages 66–89 years between 1992 and 2007. We performed one-to-one matching on time-dependent propensity score on the day of adjuvant chemotherapy initiation within 6 months after the first cancer-directed surgery based on the estimated probability of chemotherapy initiation at each day for each patient, using a Cox proportional hazards model. We estimated the cumulative incidence of AKI using Kaplan–Meier methods. We used Cox proportional hazards models to evaluate the association between chemotherapy and the risk of AKI, and compared the risk among major chemotherapy types.

Results

The study included 28,048 women. The 6-month cumulative incidence of AKI was 0.80% for chemotherapy-treated patients, compared with 0.30% for untreated patients (P < 0.001). Adjuvant chemotherapy was associated with a nearly threefold increased risk of AKI [hazard ratio (HR) 2.73; 95% CI 1.8–4.1]. Compared with anthracycline-based chemotherapy, the HRs (95% CIs) were 1.66 (0.94–2.91), 0.88 (0.53–1.47), and 1.15 (0.57–2.32) for taxane-based, CMF, and other chemotherapy, respectively.

Conclusion

Our findings showed that adjuvant chemotherapy was associated with increased risk of AKI in elderly women diagnosed with early-stage breast cancer. The risk seemed to vary by regimen type, but the differences were not statistically significant.

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Acknowledgements

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The authors thank Chronic Disease Research Group colleagues Anne Shaw and Delaney Berrini, BS, for manuscript preparation, and Nan Booth, MSW, MPH, ELS for manuscript editing.

Funding

This work was supported by the Chronic Disease Research Group, Minneapolis Medical Research Foundation.

Author information

Affiliations

  1. Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S2.100, Minneapolis, MN, 55404, USA

    Shuling Li, Jiannong Liu & Allan J. Collins

  2. Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Beth A. Virnig

  3. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Allan J. Collins

Authors
  1. Shuling Li
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  2. Jiannong Liu
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  3. Beth A. Virnig
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  4. Allan J. Collins
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Correspondence to Shuling Li.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Li, S., Liu, J., Virnig, B.A. et al. Association between adjuvant chemotherapy and risk of acute kidney injury in elderly women diagnosed with early-stage breast cancer. Breast Cancer Res Treat 161, 515–524 (2017). https://doi.org/10.1007/s10549-016-4074-7

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  • DOI: https://doi.org/10.1007/s10549-016-4074-7

Keywords

  • Acute kidney injury
  • Adjuvant chemotherapy
  • Breast cancer
  • Medicare