Phenotypes and Baseline Risk Factors of Acute Kidney Injury in Children After Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Background: Acute kidney injury (AKI) is a frequent and widely recognized complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Despite relatively high prevalence, AKI after allo-HSCT and its risk factors in children remain obscure. The aim of this study was to describe the prevalence and course of AKI during the first 100 days after allo-HSCT in children and to investigate its associations with baseline characteristics. Methods: Retrospective single-center chart review of all patients under 18 who underwent allo-HSCT during 2011-2017 was performed. AKI was defined using the pediatric RIFLE criteria and only the patients with pRIFLE stage I (eGFR decrease by 50% or more) or higher were considered for the analysis. Recurrent AKI and acute kidney disease (AKD) were defined according to the Acute Disease Quality Initiative consensus. Demographic, clinical, and procedure-related characteristics were recorded at the day of HSCT. Conclusions: AKI is a frequent early complication of allo-HSCT in children, and approximately one fifth experience AKI recurrence and one third develop AKD. Older age, higher BMI, and higher eGFR at the day of transplant may have an effect on the risk of AKI development and its course.

Assessment of Risk Factors for Acute Kidney Injury with Machine Learning Tools in Children Undergoing Hematopoietic Stem Cell Transplantation

“…The above-mentioned anomalies, both altering serum creatinine values and subsequently aggravating hyperfiltration, justify such assessment, although imperfect, among the hematological protocols of kidney function evaluation [32][33][34]. The concomitant existence of two eGFR values, before and just after HSCT, in one model indirectly confirms previous observations of high eGFR values' influence on AKI recurrence in HSCT children [11]. It also suggests the significance of a preserved renal functional reserve (RFR), represented here by the most prominent increase in eGFR value 24 h after HSCT versus the pre-transplantation record, for the prediction of AKI incidence [35,36].…”

“…Other studies confirm the influence of unrelated donors, underlining the additional roles of viral infections, malignant disease as the indication, drug nephrotoxicity, complications like thrombotic microangiopathy, or an older child's age, in aggravating the risk of AKI development after HSCT [6][7][8][9][10]. Recent data also point to the impact of initially increased estimated glomerular filtration rate (eGFR) values on further AKI recurrence [11].…”

Recent Advances of Acute Kidney Injury in Hematopoietic Cell Transplantation

“…Representative studies that focus on the association of AKI with transplant outcomes are shown in Table 2. In pediatric HCT recipient, the incidence of AKI is similar to adults (44,48,49,(56)(57)(58), AKI worsens mortality after HCT (49,57), and the 1-year survival rate is less than 10% in patients with renal failure requiring renal replacement therapy (56). Fortunately, HCT-related AKI has decreased in recent years due to the increased use of less toxic conditioning regimens, decreased rates of SOS, modified infection prophylaxis, less amphotericin B use, and declining rates of severe aGVHD (59,60).…”

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][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][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.…”