Patients With CKD Are Less Likely to Receive Adjuvant Chemotherapy

Chronic kidney disease (CKD) is a common comorbidity in patients with cancer that is associated with poorer outcomes and mortality. According to the authors of a recent study, CKD “presents unique challenges” for treating patients with cancer because of the impact of impaired kidney function on treatment-related toxicity. Their research found that patients with CKD received adjuvant chemotherapy less frequently and concluded that individualized treatment approaches are necessary in this population to optimize cancer treatment outcomes.

In the study of 109,875 patients with cancer in Japan, 4.5% had CKD. Of patients with CKD, 42% received adjuvant chemotherapy compared to 65% of patients with CKD, and patients with CKD had lower odds of receiving standard chemotherapy regimens.

CKD is an independent risk factor for cancer mortality, contributes to poor prognosis in cancers, and increases the complexity of treatment decisions, the authors said. Impaired kidney function often requires adjusting doses of chemotherapy agents or choosing alternative agents to avoid toxicity. Because of these challenges, they wrote, “concerns are growing that patients with cancer and CKD may not be receiving adequate oncological care.” However, they added, there is a lack of research exploring this possibility.

The retrospective study used a hospital-based cancer registry in Japan and investigated the prevalence of adjuvant chemotherapy in patients with CKD and evaluated additional factors associated with receiving adjuvant chemotherapy. Adult patients in the registry with colon, gastric, breast, or non-small cell lung cancer who underwent curative surgery over a 3-year period were included. A total of 109,875 patients were included, and 4.5% (4953) had CKD.

Patients with CKD were older and had a higher prevalence of comorbidities. The proportion of patients receiving adjuvant chemotherapy was significantly lower among those with CKD: 42% of patients with CKD and 65% of patients without CKD (P < .001). The likelihood of receiving adjuvant chemotherapy was significantly lower among patients with CKD

(OR, 0.51; P < .001), after adjustment for confounding factors.

Additional factors associated with the likelihood of receiving adjuvant chemotherapy included age, reduced functional independence, and comorbidities. Patients between the ages of 65 and 75 (OR, 0.62; P < .001) or older than 75 (OR, 0.15; P < .001) were significantly less likely to receive adjuvant chemotherapy than younger patients. Lower Barthel Index scores, indicating reduced functional independence, were also associated with lower odds of adjuvant chemotherapy (OR, 0.32 for scores 60-95, 0.09 for scores < 60 compared to score of 100; P < .001 for both). Comorbidities were associated with a 19% lower likelihood of receiving adjuvant chemotherapy (P < .001).

The use of standard and non-standard chemotherapy regimens also differed between patients with and without CKD, among those being treated for colon or gastric cancer. In colon cancer, oxaliplatin monotherapy was used less frequently in patients with CKD (15% vs 45%). In gastric cancer, capecitabine monotherapy was used less frequently in patients with CKD (10% vs 33%). In contrast, taxane monotherapy was used more frequently in patients with CKD (18% vs 9%).

The investigators said their findings suggest that chemotherapy regimens are modified for patients with CKD, “likely owing to concerns about kidney function,” leading to less use of standard treatments and more use of alternative treatments such as taxanes. Their findings of less frequent adjuvant chemotherapy use in patients with CDK were consistent across all 4 cancer types included in the study.

The authors commented that there is a lack of clinical trial data on cancer treatments in patients with CKD, as many trials exclude patients with impaired kidney function, which causes challenges for clinicians to balance the risks of kidney toxicity with the potential benefits of adjuvant chemotherapy. They recommended “personalized treatment plans that incorporate close monitoring of kidney function and corresponding adjustments to drug types and dosages should be prioritized to ensure that patients with CKD receive effective yet safe cancer care.”

Reference

Ishii T, Watanabe T, Ichinose Y, Mano H, Higashi T. Adjuvant chemotherapy for patients with chronic kidney disease: a study on treatment adoption and associated factors. Cancer Med. 2025;14(17):e71237. doi:10.1002/cam4.71237