Predictors of AKI and Mortality in Patients with Cancer Who Have Undergone Nephrectomy vs. Nonnephrectomy

Background: Acute kidney injury (AKI) is linked to increased mortality, prolonged hospital stays, and greater healthcare costs. Cancer patients with nephrectomy represent a distinct population at risk for AKI due to metabolic stress, hemodynamic fluctuations, and comorbidities. This study aims to assess differences between nephrectomy and non-nephrectomy cancer patients using the National Inpatient Sample (NIS) database. Methods: We conducted a retrospective study from 2018-2022 on adult cancer patients using ICD-10 codes. The primary outcomes were AKI and inpatient mortality, with secondary outcomes of length of stay (LOS) and total hospital charges among nephrectomy versus non-nephrectomy cases. Multivariable logistic regression was used to identify predictors of AKI and mortality. Results: Among 7 million hospitalizations, 3.2 million involved cancer diagnoses, with 51,649 nephrectomy cases. AKI occurred in 731,224 admissions overall, with a higher rate in nephrectomy (31.2%) compared to non-nephrectomy patients (22.6%). Adjusted models showed age ≥60, sepsis, and Black race were associated with higher AKI risk in both groups. Female and private insurance were protective, especially among non-nephrectomy patients. Incidence of AKI rose over time, steeply in non-nephrectomy cases. Sepsis and dialysis were more strongly linked to mortality in nephrectomy patients while AKI to non-nephrectomy patients. The yearly mortality rate declined slightly among nephrectomy patients, while rising in non-nephrectomy cancer admissions. Nephrectomy patients also had a shorter LOS and lower total charges than non-nephrectomy cancer patients. Conclusion: Nephrectomy patients had a higher AKI rate but shorter hospital stays and lower costs, suggesting they are generally healthier or more optimally managed. Our findings emphasize the need for targeted AKI prevention strategies, particularly for older adults and those with sepsis.Predictors of AKIPredictors of mortality