Iago Zang Pires, Alexandre Yamada Fujimura, Marília Oberto da Silva Gobbo, Renan Yuji Ura Sudo, Tanize Louize Milbradt, Nilson Marquardt Filho, Gustavo Franco Carvalhal
ADT was associated with higher odds of AKI among patients with prostate cancer. The association was particularly evident among patients receiving GnRH agonist-based therapy. However, the findings should be interpreted in light of the observational nature of the available evidence and the methodological limitations related to the synthesis of effect estimates reported using different statistical approaches.
PURPOSE: Androgen deprivation therapy (ADT) has been associated with increased cardiovascular and renal risks in prostate cancer patients. We performed a systematic review and meta-analysis of the currently available evidence to evaluate the rates of acute kidney injury (AKI) in prostate cancer patients under ADT.
MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to October 2024. Eligible observational studies comparing prostate cancer patients receiving ADT with those not receiving ADT were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using I², τ², and 95% prediction intervals. Risk of bias and certainty of evidence were evaluated using the Newcastle-Ottawa Scale and GRADE framework, respectively. Statistical analyses were performed using R software version 4.3.1, and the study was reported according to PRISMA and MOOSE recommendations.
RESULTS: Four studies involving 72,980 patients were included. ADT was significantly associated with AKI occurrence when compared with the non-ADT control group (OR 1.34; 95% CI 1.29-1.40; p < 0.001; I2 = 68%). In a subgroup analysis, GnRH agonists demonstrated positive association with AKI risk (OR 1.49; 95% CI 1.02-2.17; p = 0.038; I2 83.1%). In contrast, orchiectomy was not associated with AKI (OR 1.1; 95% CI 0.85-1.42; p = 0.488; I2 = 0%). GnRH agonist ADT, compared to other ADT modalities, demonstrated negative association with AKI (OR 0.77; 95% CI 0.61-0.98; p = 0.035; I2 = 0%). The analysis of orchiectomy against GnRH agonist therapy suggests lower AKI rate in orchiectomized patients (OR 0.77; 95% CI 0.66-0.91; p = 0.001; I2 = 0%).
CONCLUSION: ADT was associated with higher odds of AKI among patients with prostate cancer. The association was particularly evident among patients receiving GnRH agonist-based therapy. However, the findings should be interpreted in light of the observational nature of the available evidence and the methodological limitations related to the synthesis of effect estimates reported using different statistical approaches.