Research Spotlight: Innovating kidney care in patients with cancer

Raad B. Chowdhury, MD, and Shruti Gupta, MD, MPH, are onconephrologists in the Division of Nephrology at Brigham and Women’s Hospital (BWH), a founding member of the Mass General Brigham healthcare system. They are first and senior authors, respectively, of a paper recently published in the Clinical Journal of the American Society of Nephrology, Innovating Kidney Care in Patients with Cancer: The Development of an Inpatient Onconephrology Service.

Summary:

Onconephrology is an emerging subspecialty that involves the care of patients with cancer and kidney disease. Kidney disease can occur from the cancer itself, or from complications of cancer treatment (e.g., immunotherapy, conventional chemotherapies, stem cell transplant).

Furthermore, as patients with cancer are living longer, they are more prone to developing chronic kidney disease, which can jeopardize their eligibility for other therapies and make dosing of chemotherapy more challenging. Thus, onconephrology has become an increasingly important subspecialty.

Dr. Gupta founded the American Society of Onconephrology (ASON) and served as its first president, and Dr. Chowdhury is now the vice president of ASON. The organization has members from 14 countries around the world.  

This paper is the first to describe the experience of creating a dedicated, inpatient onconephrology consult service at BWH, one of the few centers in the world with such a comprehensive practice.

Along with co-first author Jessica Ortega, a research coordinator in Dr. Gupta’s lab, Drs. Chowdhury and Gupta discuss the pathway to the creation of the service, the overall structure of the service, and some preliminary findings in the first year following the inception of the service.

They extracted data by manual chart review on consults placed by oncology to the general nephrology service (i.e., prior to the formation of the dedicated onconephrology service) from 2022-2023, and consults placed to the onconephrology service from 2023-2024.

They found that patients with cancer who had kidney injury and were seen by the onconephrology service were more likely to have kidney recovery by the time of discharge compared to patients who were seen by the general consult service.

They also anonymously surveyed oncologists and advanced practice providers who are responsible for communication with subspecialists, including nephrologists.

Importantly, 81% of the providers surveyed felt that the service was useful, and 88% said it was very likely that they would utilize the onconephrology consult service again for future patients.  The new service has also allowed patients to seamlessly transition from the hospital setting to the outpatient onconephrology clinics for follow-up and longitudinal care.

What question were you investigating?

We were describing the creation of our innovative service, assessing perception of our service in the first year, and also examining whether having a dedicated inpatient consult service to care for patients with cancer and kidney disease would have a positive impact on patient outcomes.  

What methods or approach did you use? 

We manually reviewed the charts of patients admitted to oncology and seen by general nephrology between July 2022-June 2023, along with those patients for whom the new  onconephrology service was consulted between  July 2023-June 2024. We compared recovery from acute kidney injury, improvements in sodium levels in patients who developed low sodium issues as a result of their cancer or their treatments, and several other key outcomes. We also assessed overall perceptions of our service by the oncology teams.

What did you find? 

We found that patients with acute kidney injury who were cared for by onconephrology were more likely to have kidney recovery at sign off or discharge from the hospital, compared with patients with cancer who were cared for by the general nephrology service in the preceding year. We found no difference in sodium levels at the time of sign-off or discharge between services. We found that oncology providers found our service overwhelmingly useful and would consult onconephrology again.

What are the implications?

This is the first study to document the creation of a dedicated inpatient onconephrology service. We highlight some of the challenges and future directions as well.  We hope that this sets a standard for other centers who are interested in building an onconephrology practice.  

What are the next steps?

In the future, we would like to more rigorously examine outcomes among patients with cancer who are cared for by our service. On a larger level, we also hope to continue to partner with oncologists to identify ways to improve the care of our patients with cancer who develop kidney-related issues.

Authorship:

Chowdhury, Raad B.; Ortega, Jessica L.; Wells, Sophia L.; Pirovano, Marta; Kim, Raphael; Lima, Carolina S.; Madken, Mohit; Khalid, Sheikh B.¹; El Fekih, Rania; Alikhan, Firasat M.; Peterkin, Alexa C.; McMahon, Gearoid M.; Mount, David B.; Bonventre, Joseph V.; Gupta, Shruti

Paper cited: Chowdhury RB, Ortega JL, Wells SL, et al. Innovating Kidney Care in Patients with Cancer: The Development of an Inpatient Onconephrology Service. Clin J Am Soc Nephrol. Published online March 19, 2025. doi:10.2215/CJN.0000000714

Disclosures:  RBC has no relevant disclosures

About Mass General Brigham

Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org.