Androgen deprivation therapy was associated with a third higher odds of AKI

Design

Systematic review and meta-analysis of observational studies

Population

72,980 men with prostate cancer in 4 studies

Primary outcome

Acute kidney injury

Effect

OR 1.34 (95% CI 1.29–1.40); GnRH agonists OR 1.49 (1.02–2.17)

This meta-analysis pooled four observational studies with 72,980 men with prostate cancer, comparing those on androgen deprivation therapy (ADT) with those not.

ADT was associated with higher odds of AKI (OR 1.34, 95% CI 1.29–1.40), with moderate heterogeneity (I² 68%). The association was seen with GnRH agonists (OR 1.49) but not with orchiectomy (OR 1.1, 0.85–1.42), and orchiectomy was associated with lower AKI rates than GnRH agonists.

The mechanism is unclear and the data are observational, with few studies. For nephrologists, the practical point is to recognise ADT as a possible contributor when an older man with prostate cancer presents with AKI, and to check kidney function during treatment.

• Ask about androgen deprivation therapy when assessing AKI in older men.
• Check creatinine at baseline and periodically during ADT, especially with CKD or other nephrotoxins.
• Review concurrent nephrotoxic drugs and volume status in men on ADT.
• Do not stop ADT on kidney grounds without discussing with the oncology or urology team.

Why it matters

It adds AKI to the cardiometabolic harms already linked to ADT.

Don't overread it

This is an association from four observational studies; it does not show ADT causes AKI.

The statistics, in plain English

An odds ratio of 1.34 means about a third higher odds of AKI with ADT. With only four observational studies and I² of 68%, confounding by age, cancer stage and other drugs may explain part of this.

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