1. Acute kidney injury in cancer patients Wim Van Biesen for Norbert Lameire Em prof of Medicine University Hospital Gent, Belgium Tbilisi, october 2015

2. Cumulative incidence (risk) of AKI during the first 5 years after a cancer diagnosis Christiansen et al. / European J Int Med 22 (2011) 399–406 37,267 incident cancer patients -5yrs FU 9613 (25.8%) developed AKI 1-yr risk:17.5% 5-yr risk: 27.0% mortality R I F

3. The timing of AKI, presented as percentages of total AKI against days after admission to the cancer center. Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013. * 12% of all admissions to cancer center over 3 month period had AKI * Most cases seen in recent admissions

4. Main associated factors of AKI in cancer patients(n: 309) Soares et al, J Clin Oncol 24:4003-4010, 2006

5. Kaplan-Meyer survival curve for 90 days after admission to the cancer center based on AKI severity by RIFLE Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013

6. Length of hospital stay Hospital bills Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013

7. Length of hospital stay Hospital bills Salahudeen et al, Clin J Am Soc Nephrol 8: 347–354, 2013 Large confidence intervals

8. Effect of AKI on outcomes of cancer patients Campbell et al, Adv CKD, 2014, 21: 64-71

9. Anticancer therapies requiring dosage adjustment as a percentage of prescriptions (A) and as a percentage of treated patients (B). Launay-Vacher et al, Cancer 2007;110:1376–1384.

10. S crea = 1.5: what about renal function???

11. Patient-specific factors that increase risk for chemotherapy- asssociated nephrotoxicity Shirali, Perazella, Adv CKD, 2014, 21: 56-63,

12. Categories of chemotherapy- Induced nephrotoxicity Perazella, Moeckel, Semin Nephrol 30:570-581, 2010

13. Pathophysiology of cisplatinum nephrotoxicity Pabla N, Dong Z. Kidney Int 73: 994–1007, 2008.

14. Magnesium supplementation in prevention of cisplatinum nephrotoxicity Kidera et al, PLoS ONE 9(7): e101902., 2014

15. Comparison of cis-platin with its Second and Third Generation Platinum Analogues Ali et al, Anti-Cancer Agents in Medicinal Chemistry, 2013, 13, 296-306

16. Purine metabolism- uric acid is the endproduct in humans Wilson, Berns Adv CKD, 2014, 21: 18-26

17. The Cairo-Bishop Definitions of laboratory and clinical Tumor Lysis Syndrome Wilson, Berns Adv CKD, 2014, 21: 18-26

18. Reported incidences of TLS stratified by Risk Category Wilson, Berns Adv CKD, 2014, 21: 18-26

19. Flowchart of patients included in the study according to the presence of TLS Darmon et al, British Journal of Haematology, 2013, 162, 489–497

20. Prophylaxis and Treatment of Tumor Lysis Syndrome Denker et al, European J Int Med 22 (2011) 348–354

22. Only 1 RCT 7 observational historical control

29. Risk of AKI associated with androgen deprivation therapy for advanced prostate cancer (observational) Lapi et al, JAMA. 2013;310(3):289-296.

30. Cumulative incidence plot depicting the rates of AKI after stratifying patients according to the type of androgen deprivation for non metastatic prostate Ca (gonadotropin releasing agonists) Gandaglia et al, EUROPEAN UROLOGY 66 (2014) 1125–1132

31. Mechanisms of FLCs-induced kidney injury Davenport, Merlini, Nephrol Dial Transplant (2012) 27: 3713–3718

32. Probability of renal recovery following sustained reduction in free light chain levels at day 21 in myeloma kidney. Hutchison et al. J. Am. Soc. Nephrol. 22, 1129–1136 © 2011

33. Combination of bortezomib-based chemotherapy and extracorporeal free light chain removal for treating cast nephropathy in MM-2 cases Bachmann et al, NDT Plus (2008) 2: 106–108

34. Figure 2. Forest plot of weighted risk ratio comparing 6-month survival rate between chemotherapy with plasmapheresis and chemotherapy only group. International Journal of Clinical Pharmacology and Therapeutics, Vol. 53 – No. 5/2015 (391-397)

35. Figure 3. Forest plot of weighted risk ratio comparing 6-month dialysis-dependent rate between chemotherapy with plasmapheresis and chemotherapy only group. International Journal of Clinical Pharmacology and Therapeutics, Vol. 53 – No. 5/2015 (391-397)

36. Novel approaches for reducing free light chains in patients with myeloma kidney Hutchison, C. A. et al. Nat. Rev. Nephrol. 8, 234–243 (2012 )

37. General conclusions Be aware of renal probems in patients with cancer Acute Kidney Injury Chronic Kidney injury Keep it simple: rehydration dose-adaptation most “exciting new promising” therapies NOT supported by evidence