Pharmacotherapy. 2023 Nov 5. doi: 10.1002/phar.2889. Online ahead of print.
ABSTRACT
PURPOSE: Acute kidney injury (AKI) commonly occurs in patients with lymphoma exposed to high-dose methotrexate (HDMTX), but our ability to reliably predict AKI is limited. This study sought to develop and validate a model for predicting AKI after HDMTX exposure.
METHODS: This multisite, retrospective study of consecutive adult lymphoma patients treated with HDMTX used the LASSO method to identify factors available at the outset of therapy that predicted incident AKI within 7 days following HDMTX. The model was then validated in an independent cohort.
RESULTS: The incidence of AKI within 7 days following HDMTX was 21.6% (95% Confidence Interval (CI) 18.4%-24.8%) in the derivation cohort (435 unique patients who received a total of 1,642 doses of HDMTX) and 15.6% (95% CI 5.3%-24.8%) in the validation cohort (55 unique patients who received a total of 247 doses of HDMTX). Factors significantly associated with AKI after HDMTX in the multivariable model included age ≥ 55 years, male sex, and lower HDMTX dose number. Other factors that were not found to be significantly associated with AKI on multivariable analysis, but were included in the final model, were body surface area, Charlson Comorbidity Index, and estimated glomerular filtration rate. The c-statistic of the model was 0.72 (95% CI 0.69-0.75) in the derivation cohort and 0.72 (95% CI 0.60-0.84) in the validation cohort.
CONCLUSION: This model utilizing identified sociodemographic and clinical factors is predictive of AKI following HDMTX administration in adult patients with lymphoma.
PMID:37926860 | DOI:10.1002/phar.2889
