Adjuvant Chemotherapy for Patients With Chronic Kidney Disease: A Study on Treatment Adoption and Associated Factors

Introduction

Patients with chronic kidney disease (CKD) face unique challenges in cancer treatment, including the need for chemotherapy dose adjustments and avoiding nephrotoxic agents, often leading to less aggressive treatment. However, little is known about the real-world administration of adjuvant chemotherapy for patients with CKD. In this study, we aimed to investigate the prevalence of adjuvant chemotherapy in patients with CKD and to explore factors influencing chemotherapy use.

Methods

We retrospectively analyzed data from the Diagnosis Procedure Combination survey and hospital-based cancer registry in Japan. Adult patients diagnosed with colon, gastric, breast, or non-small-cell lung cancer who underwent curative surgery from January 2016 to December 2019 were included. CKD was identified based on International Classification of Diseases, 10th revision codes, and CKD-related medication prescriptions. The primary outcome was the proportion of patients receiving adjuvant chemotherapy, and secondary outcomes were regimen details.

Results

A total of 109,875 patients were included in the study, 4.5% (4953) of whom had CKD. Patients with CKD were older and had a higher prevalence of comorbidities. A smaller proportion of patients with CKD received adjuvant chemotherapy (41.7% vs. 64.5%, p < 0.001). CKD was independently associated with lower odds of receiving adjuvant chemotherapy (odds ratio: 0.51, 95% confidence interval: 0.48–0.55). Patients with CKD were also less likely to receive standard chemotherapy regimens or those requiring dose adjustments.

Conclusions

Patients with CKD received adjuvant chemotherapy less frequently, likely owing to concerns about kidney toxicity and dose adjustments. Individualized treatment approaches are needed to optimize outcomes for this population.