Incidence and Risk Factors for Acute Kidney Injury after Allogeneic Stem Cell Transplantation: A Prospective Study

Abstract

(1) Background: Acute kidney injury (AKI) is a serious complication of hematopoietic stem cell transplantation (HSCT). (2) Methods: The aim was to identify the incidence, severity, and risk factors for AKI during the first 100 days after allo-HSCT; we performed a prospective observational study on 135 consecutive patients. (3) Results: The mean age was 38.3 ± 11.9 years (50.6% females), AKI developed in 93 patients (68.9%), the median time of appearance was 28 days, and the mean serum creatinine at the time of AKI was 1.8 ± 0.8 mg/dL. A total of 36 (38.7%) patients developed stage 1 AKI, 33 (35.5%) patients developed stage 2, and 24 (25.8%) patients developed stage 3; eight (8.6%) patients required temporary hemodialysis, and the mortality rate in these patients was 87.5%. Death was twice as frequent in the AKI subgroup, without statistical significance. Cyclosporine overdose (HR = 2.36, 95% CI: 1.45–3.85, p = 0.001), tacrolimus overdose (HR = 4.72, 95% CI: 2.22–10.01, p < 0.001), acute graft-versus-host disease (aGVHD) (HR = 1.96, 95% CI: 1.13–3.40, p = 0.01), and CRP level (HR = 1.009, 95% CI: 1.007–1.10, p < 0.001) were independent risk factors for AKI. Sepsis (HR = 5.37, 95% CI: 1.75–16.48, p = 0.003) and sinusoidal obstruction syndrome (HR = 5.10, 95% CI: 2.02–12.85, p = 0.001) were found as independent risk factors for AKI stage 3. (4) Conclusions: AKI occurs with high incidence and increased severity after allo-HSCT. Careful monitoring of calcineurin inhibitors and proper management of sepsis may reduce this risk.

Predictive Risk Score for Acute Kidney Injury in Hematopoietic Stem Cell Transplant

“…In our study, 59.1% of patients undergoing HSCTs developed AKI as defined by the KDIGO classification considering both creatinine and urinary output criteria in the first 100 days after HSCT. This cumulative incidence is in the range of recent studies (49.2-68.9%) that consider KDIGO classification-either by creatinine criteria alone [12,14,18] or by both creatinine and urinary output criteria [15,16] in populations with different hematologic malignancies undergoing HSCTs.…”

“…These same studies consistently associated AKI in the first 100 days after HSCT with lower overall survival-Kanduri et al (2020) published a meta-analysis [13] showing pooled odds ratios of 3-month mortality and 3-year mortality among patients undergoing HSCT with AKI were 3.05 (95% CI 2.07-4.49) and 2.23 (95% CI 1.06-4.73), respectively, with higher mortality in more severe stages. Also, Gutierrez et al [14] and Andronesi et al [18] found an association between AKI in allogeneic HSCTs and progression to CKD in HSCTs. These findings reinforce the importance of identifying patients at risk to implement prevention measures and early approach.…”

“…In the last five years, studies have been published on AKI in HSCTs showing an incidence above fifty percent in most studies and a consistent prognostic impact on overall survival, especially in the higher stages of AKI [12,[14][15][16][17][18].…”

Risk Factors for Acute Kidney Injury after Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

“…1). Among included studies, four were prospective and 16 were retrospective [10, 11, 13–30]. A total of 4,378 patients who underwent HSCT were included in the 20 studies, including 2,219 and 2,159 patients with and without AKI, respectively.…”

“…Recent studies have revealed that some risk factors, such as myeloablative conditioning (MAC), sinusoidal obstruction syndrome (SOS), and allogeneic HSCT, contribute to AKI [10, 11]. However, the risk factors correlated with AKI after HSCT remain unclear.…”