The association between kidney failure and hormone therapy in prostate cancer

This study examined whether androgen deprivation therapy given as treatment for prostate cancer patients increases the risk of kidney injury.

Androgens are a group of hormones (such as testosterone) which can stimulate the growth and spread of prostate cancer cells. Androgen deprivation therapy (ADT) reduces the amount of testosterone produced in the body, or inhibits the stimulating effect of testosterone on cancer cells. Several drugs can be used in ADT, including gonadotropin-releasing hormone agonists (GnRH agonist), anti-androgens and estrogens.

ADT causes cancer cells to shrink, or grow more slowly, but it can also have serious side effects.  For instance, ADT can lead to high blood sugar levels (hyperglycemia) and high levels of cholesterol, both of which are risk factors for acute kidney injury (AKI). AKI is an emergency condition in which the kidneys are no longer able to filter waste products from the blood. This study examined whether ADT is associated with an increased risk for AKI.

This study examined the medical records of 10,250 patients diagnosed with prostate cancer. Out of these patients, 232 patients experienced AKI. Data from these patients was compared to that of 2721 similar patients who did not experience AKI.

The comparison showed that ADT significantly increases the risk of developing AKI. Patients currently treated with ADT have a 2.5-fold increased risk of developing AKI compared to patients that never received ADT. This increase in the risk for developing AKI was mainly seen in patients receiving a specific type of ADT, involving a combination of GnRH agonists plus oral anti-androgens. This combination showed a 4.5-fold increased risk for developing AKI. The highest risk for developing AKI was seen in the first year after ADT treatment. In addition, patients were overall more likely to develop AKI if they were smokers, heavy drinkers, or if they also suffered from additional medical conditions such as diabetes or cardiovascular diseases (heart or artery disease).

In summary, ADT, and particularly GnRH agonists, increase the risk of developing AKI, especially during the first year after treatment.

This was a retrospective study (looking back into patient's medical records). These types of studies have a lower statistical power (results are less reliable) than studies directly comparing patients currently being treated.

Consult with your physician regarding the risks of ADT and how to reduce unwanted side effects after treatment.