- Design
- Systematic review and meta-analysis of 4 observational studies
- Population
- 72,980 men with prostate cancer
- Primary outcome
- Acute kidney injury with vs without ADT
- 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 of 72,980 men with prostate cancer comparing those on androgen deprivation therapy (ADT) with those not.
ADT was associated with higher odds of acute kidney injury (OR 1.34, 95% CI 1.29–1.40; I² 68%). GnRH agonists showed an association (OR 1.49, 1.02–2.17), orchiectomy did not (OR 1.10, 0.85–1.42), and orchiectomy was associated with lower AKI rates than GnRH agonists.
Only four studies contributed, with substantial heterogeneity and methodological issues in combining estimates. Possible mechanisms include hypogonadism-related metabolic and vascular effects. The practical point is modest: men on ADT are often older, with diabetes and hypertension, and their kidney function deserves attention.
- Check creatinine and eGFR at baseline and periodically in men on androgen deprivation therapy.
- Review nephrotoxic drugs — NSAIDs, contrast, aminoglycosides — in men on ADT.
- Manage the metabolic effects of ADT: glucose, lipids, blood pressure.
- Do not change ADT modality on the basis of this evidence alone.
Why it matters
It adds kidney risk to the cardiometabolic harms clinicians already monitor during ADT.
Don't overread it
Four observational studies with high heterogeneity — association only, and the modality comparisons are weak.
The statistics, in plain English
An OR of 1.34 is a moderate relative increase; the narrow interval reflects the large pooled sample, not certainty about causation.
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