Adverse Renal Outcomes in Patients With Mesothelioma-A Territory-Wide Real-World Data

Our plain-English summary of Adverse Renal Outcomes in Patients With Mesothelioma-A Territory-Wide Real-World Data, by W.C. Kwok, J.C.M. Ho, I.S.H. Leung, et al (Cancer Medicine, 2026).

The study

• Authors: W.C. Kwok, J.C.M. Ho, I.S.H. Leung, D.Y.H. Yap
• Journal: Cancer Medicine
• Published: 2026;15(2):e71595
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Advances in mesothelioma management have translated into longer patient survival and different treatment-related side effects including nephrotoxicity. The risk of developing adverse renal outcomes in patients with mesothelioma and associated risk factors remains undefined.

Methods: We analysed territory-wide data from electronic health records of patients with mesothelioma followed at public hospitals in Hong Kong between 1st January 2000 to 31st December 2022. Prevalence of acute kidney injury (AKI), renal progression (> 30 mL/min drop in eGFR), and upstaging of chronic kidney disease (CKD) and associated risk factors were evaluated.

Results: 222 patients were included. 18 (5.1%) patients developed acute kidney injury (AKI), and risk factors included diabetes mellitus (DM), use of bevacizumab and the presence of third space fluid (pleural effusion, pericardial effusion, ascites). 47 (21.2%) patients had upstage of CKD, and 31 (14.0%) patients showed renal progression. 18, 9, and 4 patients developed renal progression within 12 months from diagnosis, 12-24 months from diagnosis, and more than 24 months from diagnosis. Risk factors for upstage of CKD included the presence of third space fluid, platinum-based chemotherapy, use of immune check-point inhibitors, AKI during follow-up, more lines of cytotoxic chemotherapy received, and cycles of pemetrexed used. Predictors for renal progression included the presence of ascites and use of bevacizumab.

Conclusion: Short- and long-term adverse kidney outcomes are prevalent in patients with mesothelioma and show strong associations with treatments received. Careful patient selection and close monitoring of renal function may help avoid untoward acute and chronic nephrotoxicity.

© 2026 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.

In plain English

This retrospective study used electronic health records from Hong Kong public hospitals to examine kidney problems in 222 adults with mesothelioma, followed between 2000 and 2022. It looked at the cancer treatments patients received, not at asbestos exposure, and the records did not show whether disease was pleural or peritoneal. Eighteen patients developed acute kidney injury (printed as 5.1%, although 18 of 222 is 8.1%). Forty-seven (21.2%) moved up at least one chronic kidney disease stage, and 31 (14.0%) lost more than 30 mL/min/1.73 m2 of estimated kidney function. None developed end-stage kidney disease. After adjustment, stage worsening was associated with ascites, platinum chemotherapy, immune checkpoint inhibitors, acute kidney injury during follow-up, more lines of cytotoxic chemotherapy and more pemetrexed cycles. Bevacizumab was associated with loss of kidney function. Diabetes, bevacizumab and third-space fluid were associated with acute kidney injury. Several confidence intervals were very wide. The authors concluded that adverse renal outcomes are common in mesothelioma treatment. They noted that most patients were Chinese and that event numbers were small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study of electronic health records, with logistic regression analysis of risk factors
• Who was studied: 222 adults (aged 18 or over) with a diagnostic code of mesothelioma, managed at Hong Kong Hospital Authority public hospitals between 1 January 2000 and 31 December 2022. Mean age was 54.2 years and 152 (68.5%) were male. 251 patients were excluded under the exclusion criteria. The authors say most patients were Chinese.
• Exposure: Cancer treatments received for mesothelioma, including pemetrexed, platinum drugs (cisplatin, carboplatin), gemcitabine, bevacizumab and immune checkpoint inhibitors, along with comorbidities and third-space fluid (pleural effusion, pericardial effusion, ascites). Asbestos exposure and fiber types were not studied.
• Main results:
  • Whole cohort: 18 patients developed acute kidney injury, printed as 5.1%
  • Whole cohort: 47 (21.2%) patients had upstaging of chronic kidney disease
  • Whole cohort: 31 (14.0%) patients had renal progression (eGFR drop of more than 30 mL/min/1.73 m2)
  • Of the 31 with renal progression, 18 progressed within 12 months of diagnosis, 9 at 12 to 24 months, and 4 after more than 24 months
  • No patient developed end-stage kidney disease
  • CKD upstaging was associated with ascites: adjusted OR 9.40 (95% CI 1.84–48.07, p = 0.007)
  • CKD upstaging was associated with platinum use (aOR 5.57, 95% CI 2.03–15.30, p less than 0.001) and with immune checkpoint inhibitor use (aOR 28.81, 95% CI 2.94–282.27, p = 0.004)
  • CKD upstaging was associated with developing acute kidney injury during the follow-up period: aOR 9.84 (95% CI 2.38–40.76, p = 0.002)
  • CKD upstaging was associated with the number of lines of cytotoxic chemotherapy (aOR 2.11, 95% CI 1.31–3.40) and with the number of pemetrexed cycles (aOR 1.06, 95% CI 1.01–1.10, p = 0.011)
  • Renal progression was associated with bevacizumab use: aOR 13.19 (95% CI 1.81–96.19, p = 0.011)
  • Acute kidney injury was associated with diabetes mellitus: adjusted OR 23.13 (95% CI 1.96–272.62) in Table 2
  • Acute kidney injury was associated with bevacizumab (adjusted OR 61.67, 95% CI 2.01–1896.05) and with third-space fluid (adjusted OR 8.19, 95% CI 1.23–54.33) in Table 2
  • Mean time from starting bevacizumab to onset of acute kidney injury was 4.35 months (95% CI 3.34–5.26)
  • Patients who received cisplatin and those who received carboplatin did not differ significantly on any renal outcome (p greater than 0.05)
  • In a subgroup of 161 patients given NCCN-recommended treatment, results were largely consistent with the whole cohort (details in a supplementary table not included here)
• The authors' conclusion: The authors concluded that adverse renal outcomes are common in mesothelioma treatment and that distinct disease- and treatment-related risk factors are relevant to renal progression, CKD upstaging and acute kidney injury.
• Limitations the authors state:
  • Most patients were Chinese, which may affect generalizability
  • 251 patients were excluded, which reduced sample size and statistical power to detect some risk factors
  • The database lacked granular data such as smoking and drinking history
  • Anatomical subtype (pleural or peritoneal), histological subtype and staging were not available
  • Outcomes were based on eGFR and serum creatinine only, without urine output or urine protein, which may underestimate renal outcomes
  • Small event numbers led to wide confidence intervals that need careful interpretation
  • The study covered more than 20 years with differing treatment regimens

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Nephrotoxicity, EGFR, Bevacizumab, Pleural Effusion, Pericardial Effusion, Ascites, Chemotherapy.

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• Risk Factors of Hematological Toxicity of Mesothelioma Treatment-A Territory-Wide Retrospective Study — W.C. Kwok, D.Y.H. Yap, et al. (2026)
• Renal failure during chemotherapy: renal biopsy for assessing subacute nephrotoxicity of pemetrexed — M. Assayag, P. Rouvier, et al. (2017)
• Adequate nephroprotection reduces renal complications after hyperthermic intrathoracic chemotherapy — T. Markowiak, N. Kerner, et al. (2019)
• Malignant pleural mesothelioma with associated minimal change disease and acute renal failure — J.Y. Li, T.Y. Yong, et al. (2010)
• Nivolumab in pre-treated malignant pleural mesothelioma: real-world data from the Dutch expanded access program — L. Cantini, R.A. Belderbos, et al. (2020)

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