Association of medication burden and potential drug–drug interactions with acute kidney injury among critically ill patients receiving anticancer therapy at a tertiary care centre

BackgroundCritically ill patients with cancer are exposed to many drugs, including anticancer agents, antimicrobials and supportive medications, which increases the risk of nephrotoxicity and potential drug-drug interactions (pDDIs). The contribution of medication burden and pDDIs to acute kidney injury (AKI) in this population is not well characterised.ObjectiveTo assess the association of medication burden and pDDIs with AKI among critically ill patients receiving anticancer therapy.MethodsThis retrospective observational study was conducted in the intensive care units (ICUs) of a tertiary care centre from August 2025 to September 2026. Adults with malignancy who received anticancer therapy within 30 days before or during ICU stay were included. AKI was defined and staged by KDIGO criteria. Medication burden (total drugs and nephrotoxic drugs) and pDDIs (screened using a standard interaction database) were recorded. Multivariable logistic regression was used to identify independent predictors of AKI.ResultsOf 210 patients, 86 (41.0%) developed AKI. Patients with AKI had a higher median number of drugs (11 vs 8, p < 0.001) and pDDIs (6 vs 3, p < 0.001). Independent predictors of AKI were ≥10 distinct drugs (aOR 2.62; 95% CI 1.32-5.18), at least one nephrotoxicity-related pDDI (aOR 2.87; 95% CI 1.43-5.76), APACHE II score (aOR 1.09 per point), pre-existing CKD, sepsis, and cisplatin exposure. In-hospital mortality was higher with AKI (39.5% vs 21.8%, p = 0.007).ConclusionHigh medication burden and nephrotoxicity-related pDDIs were independently associated with AKI in critically ill cancer patients. Routine pharmacist-led medication review and renal-focused interaction screening may help reduce preventable kidney injury.