Chapter 3: AKI Associated With Malignancies

Advances in treatment, risk stratification, and supportive care have improved survival of patients with cancer over the last two decades (1). AKI may result from the cancer itself (e.g., infiltration or obstruction), the treatment of cancer (e.g., chemotherapy toxicity), or associated complications (e.g., sepsis). Cancer, by itself, is not a contraindication for starting RRT, even in the setting of multiorgan failure (2–4). However, decision-making is complex and requires a multidisciplinary approach between the oncologist, intensivist, and nephrologist. The development of AKImay lead to longer length of hospital stay, decreased functional status and quality of life, and exclusion from further cancer therapy. AKI and RRTmay lead to unpredictable levels of chemotherapeutic agents and anti-infective drugs. AKI may also increase inflammatory cytokines in the lung, leading to increased vascular permeability (5) and the need for mechanical ventilation (6). Therefore, early detection and prevention of AKI is crucial in patients with cancer.