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A recent JAMA article says there is an increased risk of kidney failure if one takes lupron or other such anti androgen drugs.
that is not the conclusion of this study. The conclusion is stated as
In a cohort of patients with newly diagnosed nonmetastatic prostate cancer, the use of ADT was significantly associated with an increased risk of AKI (acute kidney injury) . These findings require replication in other well-designed studies as well as further investigation of their clinical importance.
The design of this study is not clear. For a start it is a retrospective study, which is one of the weaker approaches and although it is difficult to make any real judgement without a deal more information - reading the full study would be a place to start.
The only clear aspect is that of the 10,250 men in the study, there were 232 who had acute kidney injury (AKI) which is not defined in the abstract so we don't know how serious mthat is - but that is less than 3% of the men in the study, so that does not seem to be too big a risk. There appears to be a difference in the number of 'non-ADT' men who suffered acute kidney injury but how many such men were there in the study? The Abstract says {i].....patients with incident AKI during follow-up who were randomly matched with up to 20 controls on age, calendar year of prostate cancer diagnosis, and duration of follow-up. [/i] That seems a bit vague to me.
It is also important to note two things:
1. Although this study attempts to ascertain if ADT results in AKI, there is no mention if there is a better or worse outcome as far as PCa is concerned. In other words, is it better to take a slight increase in kidney problems because the outcome as far as prostate cancer is concerned is better?
2. There was a a greater correlation where the men had multiple therapies.
3. The clinical value of the study is not clear.
As with all scientific studies, the devil is in the detail.
Did you find that Don's post was inaccurate because he used the term 'kidney failure' rather than "acute kidney injury"? I, myself, wondered if the two terms are synonymous, so I Googled them and it turns out that Acute Kidney Injury has replaced kidney failure as the accepted definition.
It would have made no differnce if Don had said .... there is an increased risk of kidney failure if one takes lupron or other such anti androgen drugs. or .... there is an increased risk of acute kidney injury (AKI) if one takes lupron or other such anti androgen drugs. my answer would be the same - that is NOT what trhe study says.
Let me try this again. You found Don's post to be lacking because he did not specify that the study only involved men with newly diagnosed non-metastatic cancer, meaning not cancer patients in general.
No Jack. It was because he was extrapolating the particular to the general.
Here we had a study that look at a group of men, chosen specifically to meet the criteria of the study, whose kidney health was compared with another group of men. In making this comparison, the authors of the study had noted that there was an association between a small but statistical increase in AKI amongst the men who had ADT which was not apparent in the men who did not have ADT. The association between increased levels of AKI was greater where multiple therapies had been applied. As we all know correlation is not the same as causation, so it could not be said that the ADT CAUSED the AKI merely that there is an APPARENT CORRELATION between ADT and AKI. There was no clinical value in this observation.
Given these broad nature of these findings, the generalised statement that .... there is an increased risk of kidney failure if one takes lupron or other such anti androgen drugs. which implies causation of AKI by Lupron specifically and “other such anti-androgen drugs” is simply not supported by the study.
In commenting on Don’s original post I was hoping to emphasise the nature of scientific studies. They very rarely draw the firm conclusions that the popular press headlines. This one doesn’t either.
Terry, Had you said all that in the first place I would not have asked any inane questions. LOL
Dr. Meyers echoes your explanation in a follow-up comment to his July 24 video. Based on his extensive research background, he concludes that survey research (of which the ADT/kidney injury study I believe is one) can NEVER (his emphasis) prove causal link, but only association.
