MO144: Behind the Scenes: A Year in an Onco-Nephrology Outpatient Clinic in Italy
Authors: Pirovano Marta , Cosmai Laura , Vanessa Re Sartò Giulia , Bramati Annalisa , La Verde Nicla , Gallieni Maurizio 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The progressive increasing awareness of the need for a multidisciplinary management of cancer patients, the rapid development of new anti-cancer therapies, the prolongation of oncological patients’ survival and the increased incidence of chronic kidney disease (CKD) over the years have created a breeding ground for the affirmation of onconephrology. This subspeciality of nephrology aims to fully deal with the complex and bidirectional relationship between cancer and the kidneys: on one hand, the tumour presence or its treatment can cause renal damage; on the other hand, a kidney disease can alter the bioavailability and therefore the effectiveness of the treatment itself.
Well-defined multidisciplinary management of cancer patients with kidney disease can thus ensure that the highest quality of care could be administered by a dedicated team with experience in these complex issues.
The objective of our study was to describe patients who were referred to our onconephrology clinic during 2021, in order to offer an analysis of their main characteristics, with the overall aim of providing experience-based considerations that will initiate further discussion on this growing subspecialty area.

METHOD
We performed a retrospective data collection of naive patients attending our onconephrology outpatient clinic over a 1-year period. We collected data regarding epidemiological characteristics, renal function, primary tumour, cancer therapy and reason why they were referred for a nephrological evaluation. Main characteristics of the patients are summarized in Table 1.

RESULTS
A cohort of 323 consecutive visits was analysed; 175 new cases; 110 males and 65 females, with an average age of 70 years. eGFR by CKD-EPI was 43 mL/min/1.73 m2 (5% CKD stage I, 12% stage II, 19% stage IIIA, 39% stage IIIB, 21% stage IV, and 4% stage V—FIG 1A). Primary tumours of the patients are summarized in Figure 1B.
A total of 37 first and 81 subsequent consultations were performed for clinical evaluation, 30 versus 7 for worsening CKD, 23 versus 10 for a pre-contrast enhanced computed tomography, 19 versus 16 for renal toxicity from cancer treatment, 15 versus 5 for electrolyte disturbances, 13 versus 9 in light of the possible initiation of an oncological therapy, 12 versus 9 for acute kidney injury, as summarized in Figure 1C. Overall, 93 patients (53%) were not on active oncological therapy, while, among the others, 18 received cytotoxic chemotherapy, 25 molecularly targeted agents, 22 immunotherapy, 8 hormone therapy and 9 combination of agents of multiple classes (Figure 1D).

CONCLUSION
The above retrospective results shed light on the main causes of access to an onco-nephrology outpatient clinic, once again confirming both the relevance of onconephrological issues and the increasing necessity to address them in a dedicated setting. Since onconephrology is presently more experience-based than evidence-based, and since only with a thorough knowledge of the issues of onco-nephrology, together with a tight interspecialty collaboration, we can provide these patients better treatment and management, the representative set of patients we presented can be useful to understand their commonest needs and to increase the awareness on these issues, still too often underrecognized and undermanaged, due to a certain nihilistic attitude towards cancer pts with kidney issues. Finally, preliminary efficacy results (not reported here) suggest a clinically relevant benefit in terms of nephrological outcome.