Can Axitinib Cause Polyuria?
Polyuria is not a recognized adverse effect of axitinib based on available clinical evidence and guidelines. The provided evidence does not document polyuria as a side effect of this VEGFR tyrosine kinase inhibitor used in renal cell carcinoma treatment.
Documented Adverse Effects of Axitinib
The most common adverse events associated with axitinib therapy include 1:
- Hypertension (84% incidence, with 70% grade ≥3) 2
- Hand-foot syndrome (75% incidence, with 22% grade ≥3) 2
- Diarrhea (64% incidence, with 5% grade ≥3) 1, 2
- Fatigue 1
- Nausea and vomiting 1
- Proteinuria (28% developed proteinuria ≥2g/24h requiring dose modification) 2
Renal-Specific Considerations
Proteinuria, not polyuria, represents the primary renal adverse effect of axitinib 2, 3. Key points regarding renal effects:
- Baseline urine protein levels strongly predict development of significant proteinuria (≥2g/24h) with a hazard ratio of 5.457 (p=0.0035) in patients with baseline proteinuria ≥1+ versus <1+ 2
- Proteinuria was a major cause for treatment discontinuation in clinical trials 2
- Axitinib pharmacokinetics and safety profiles remain similar regardless of baseline renal function, including in patients with severe renal impairment 4
- No starting-dose adjustment is needed for patients with pre-existing mild to severe renal impairment 4
Monitoring Recommendations
For patients on axitinib therapy, the NCCN recommends 5:
- Comprehensive metabolic panel at baseline and every 6 months for the first 2 years, then annually up to 5 years 6
- Regular monitoring for hypertension, which occurs in the majority of patients 1, 2
- Urine protein assessment, particularly in patients with baseline proteinuria 2
Clinical Pitfall to Avoid
Do not confuse polyuria with the well-documented proteinuria associated with axitinib. If a patient on axitinib presents with increased urination, consider alternative etiologies such as uncontrolled diabetes, hypercalcemia (which can occur in RCC), or other medications, rather than attributing it to axitinib 5, 6.