A systematic review of acute kidney injury in pediatric allogeneic hematopoietic stem cell recipients

Abstract

The process of allogeneic HSCT in children is associated with frequent AKI and mortality, but the epidemiology is not widely reported. The aim of this review was to summarize the available evidence on incidence, risk factors, timing, and prognosis of AKI in children following HSCT. We systematically reviewed all observational studies reporting incidence and outcomes of AKI in pediatric allogenic HSCT recipients. The minimum criteria for AKI were defined as an increase in sCr ≥ x1.5 or urine output ≤0.5 mL/kg/min over six h. Medline and Embase were searched until March 2014. From 993 electronic records, five were eligible for inclusion (n = 571 patients). The average incidence of AKI within the first 100 days following HSCT was 21.7% (range 11-42%), and the average time of onset was 4-6 wk post-transplant. Risk factors for AKI included cyclosporine toxicity, amphotericin B and foscarnet, SOS, and having a mismatched donor. There were conflicting reports on whether AKI was associated with the development of CKD. AKI is a common and potentially life-threatening complication following HSCT in children. Further quality observational studies are needed to accurately determine the epidemiology and prognosis of AKI in this population.

Acute Kidney Injury and the Risk of Mortality in Children Undergoing Hematopoietic Stem Cell Transplantation

“…Recently, Ileri et al 21 published a prospective study of 61 pediatric myeloablative and allogenic HSCT recipients and reported the incidence of AKI to be 42% within the first 100 days posttransplant. A recent systemic review of AKI in pediatric HSCT recipients included five observational studies and concluded that one-third of pediatric HSCT recipients developed AKI 10 . The cited studies used doubling of serum creatinine as their criterion for diagnosis of AKI except for Ileri et al The incidence of AKI in these studies is substantially lower than in the present study.…”

“…Pediatric data have identified sepsis, VOD, TBI, non-HLA-identical related or matched unrelated donors and nephrotoxicity associated with cyclosporine, amphotericin B and forscarnet as risk factors 20, 21, 27 . Although adult studies have elucidated myeloablative conditioning 28 , female sex, high-risk disease and aGVHD 29 as risk factors for AKI, pediatric data have not replicated these findings 10 . This may be because pediatric studies are smaller and underpowered.…”

High incidence of acute kidney injury during chemotherapy for childhood acute myeloid leukemia

“…[24][25][26][27][28][29] More than 50% of patients with childhood AML will require an allogeneic HSCT to consolidate high-risk disease or to salvage relapse disease. HSCT is a known high-risk period for children and adults to develop AKI, [43][44][45][46][47][48][49] as recently confirmed by the University of Minnesota 50 where 174 of 205 children and adolescents (84%) developed AKI during the first year following a first HSCT.…”

The role of continuous renal replacement therapy in the management of acute kidney injury associated with sinusoidal obstruction syndrome following hematopoietic cell transplantation

“…In this regard, it is critical to avoid exacerbating AKI with aggressive diuresis or rapid removal of ascetic fluid. HCT recipients often require intravenous parenteral nutrition, frequent administration of blood products, and multiple nephrotoxic medications, all of which may worsen FO, further contributing to AKI . Therefore, management of AKI and FO in HCT patients is particularly challenging; and when FO >20% or is refractory to conventional pharmaceutical diuresis, CRRT may need to be considered.…”