Androgen deprivation therapy is associated with a third more acute kidney injury

Design

Systematic review and meta-analysis of observational studies

Population

4 studies, 72,980 men with prostate cancer

Primary outcome

Acute kidney injury, ADT vs no ADT

Effect

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

This meta-analysis, published 24 September in Cancer Chemotherapy and Pharmacology, pooled four observational studies of 72,980 men with prostate cancer comparing those on androgen deprivation therapy with those not.

ADT was associated with higher odds of acute kidney injury (OR 1.34, 95% CI 1.29 to 1.40; I² 68%). GnRH agonists were associated with raised risk (OR 1.49, 1.02 to 2.17), while orchiectomy was not (OR 1.10, 0.85 to 1.42), and orchiectomy carried a lower rate than GnRH agonists directly (OR 0.77). The subgroup comparisons are internally inconsistent in places and heterogeneity was high.

The mechanism is uncertain, and the evidence is observational from only four studies. But ADT is often long-term in older men with other renal risks, so the finding supports simple monitoring rather than any change in treatment choice.

• Check creatinine at baseline and periodically in men starting androgen deprivation therapy.
• Review nephrotoxic drugs, such as NSAIDs, in men on ADT.
• Take extra care in men on ADT with diabetes, hypertension or chronic kidney disease.
• Do not switch ADT modality on this evidence alone.

Why it matters

Adds kidney injury to the list of ADT harms that need monitoring alongside cardiovascular and bone effects.

Don't overread it

Observational association from four studies; it cannot show ADT causes AKI, and the modality subgroups are inconsistent.

The statistics, in plain English

An odds ratio of 1.34 means about a third higher odds of AKI. High heterogeneity (I² 68%) and only four studies mean the true size is uncertain.

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