Androgen deprivation therapy linked to acute kidney injury

Design

Systematic review and meta-analysis of observational studies, GRADE-rated

Population

72,980 patients with prostate cancer, on versus not on androgen deprivation therapy

Primary outcome

Acute kidney injury

Effect

Odds ratio 1.34 (95% CI 1.29 to 1.40); GnRH agonists 1.49 (1.02 to 2.17); orchiectomy not associated

Androgen deprivation therapy is a mainstay of prostate cancer treatment, with known cardiovascular and metabolic effects; its renal risk is less often considered. This meta-analysis pooled four observational studies and 72,980 patients to quantify acute kidney injury on androgen deprivation therapy.

Treatment was associated with higher odds of acute kidney injury overall (odds ratio 1.34, 95% CI 1.29 to 1.40). The risk concentrated in GnRH agonist therapy (odds ratio 1.49, 95% CI 1.02 to 2.17), while surgical castration by orchiectomy was not associated with acute kidney injury, and carried lower renal risk than GnRH agonists in direct comparison.

The practical step is to keep renal function in view when starting and continuing androgen deprivation, particularly GnRH agonists — check baseline and periodic creatinine, and be cautious with nephrotoxic co-medications, contrast and volume depletion. The evidence is observational, so this is a reason for vigilance rather than a reason to withhold effective therapy.

• Meta-analysis of four observational studies, 72,980 patients with prostate cancer.
• Androgen deprivation therapy was associated with acute kidney injury (odds ratio 1.34, 95% CI 1.29 to 1.40).
• The risk concentrated in GnRH agonists (odds ratio 1.49); orchiectomy was not associated.
• Check baseline and periodic creatinine and review nephrotoxic co-medications in men on these drugs.
• Do not withhold effective therapy on this observational signal; manage the risk instead.

Why it matters

It adds renal injury to the known cardiometabolic harms of androgen deprivation, and points to the modality (GnRH agonist) that carries most of it.

Don't overread it

This was observational; it shows an association, not that androgen deprivation causes acute kidney injury or that switching modality prevents it.

The statistics, in plain English

An odds ratio of 1.34 with a tight interval above 1.0 is a consistent association, but with only four observational studies and moderate heterogeneity, confounding — sicker men receiving ADT — cannot be excluded.

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