Acute Renal Failure in Patients following Bone Marrow Transplantation: Prevalence, Risk Factors and Outcome

Chronic kidney disease (CKD) has been related to allogeneic haematopoietic cell transplantation (HCT) as a late effect caused by a variety of factors. We retrospectively evaluated the development of CKD in 230 patients, aged 34 (5-65) years, who had undergone allogeneic HCT for haematological disease, using sibling or unrelated donors and myeloablative or reduced conditioning regimens. Pre-HCT glomerular filtration rate (GFR) was within normal limits (108 ± 28 mL/min/1.73 m 2 ) in patients who did not develop CKD and 95 ± 24 mL/min/1.73 m 2 in those with CKD postHCT, while the GFR 12 months post transplant declined to 104 ± 26 and 69±19 mL/min/1.73 m 2 , respectively. CKD incidence was 20.4%, with a median time of development of 6 (3-18) months post transplant. On multivariate analysis, risk factors for CKD were the presence of chronic GVHD (cGVHD; P ¼ 0.001), unrelated donor transplantation (P ¼ 0.008), post-transplant event of acute kidney injury (AKI) (P ¼ 0.002) and older age (P ¼ 0.002). In long-term survivors stable significant predictors for CKD were older age at transplantation, cGVHD and AKI. CKD did not influence non-relapse mortality. In our study, cGVHD emerges as an important cause of kidney injury in HCT survivors, regardless of administration of nephrotoxic agents.

Section: Discussionmentioning

confidence: 99%

GVHD-associated chronic kidney disease after allogeneic haematopoietic cell transplantation

Sakellari

Barbouti

Bamichas

et al. 2013

“…The overall mortality from acute renal insufficiency was 46%, the dialyzed group having the highest mortality (88%). 7 In a prospective study of 64 adult BMT recipients, 64% of the patients developed acute renal insufficiency, ie at least doubling of pre-BMT serum creatinine concentration. 8 In our study a high pre-BMT serum creatinine, transplantation with a non-HLA-identical related or matched unrelated donor compared to a HLA-identical sibling were risk factors for the development of acute renal insufficiency in the first 3 months after BMT.…”

Section: Acute Renal Insufficiencymentioning

confidence: 99%

“…4 In another study in adults only, veno-occlusive disease and an age older than 25 years were found to be risk factors related to the development of acute renal insufficiency. 7 Besides the obvious reasons for acute renal insufficiency following BMT such as reduced renal reserve after intensive chemotherapy and the direct effect of nephrotoxic medication, the causes of renal impairment following BMT are thought to be hemodynamic in origin. In support of this assumption are the occurrence of acute renal insufficiency after septicemia (hypotension), veno-occlusive disease (hepato-renal syndrome), amphotericin B administration (renal vasoconstriction) and a high serum urea/creatinine ratio consistent with prerenal insufficiency in adult studies.…”

Section: Acute Renal Insufficiencymentioning

confidence: 99%

Bone marrow transplantation in children: consequences for renal function shortly after and 1 year post-BMT

Brand

et al. 1998

Summary:The aim of this study was to investigate the effect of a bone marrow transplantation (BMT) on renal function in children. In a 5-year period, 142 children received a BMT at the Department of Pediatrics of the University Hospital Leiden. The study was performed retrospectively using the estimated glomerular filtration rate before and 1 year after BMT, and weekly measurements of serum creatinine during the first 3 months after BMT for assessment of renal function. Patient characteristics (sex, age, diagnosis), conditioning regimen, type of BMT, major complications (sepsis, veno-occlusive disease and graft-versus-host disease (GVHD)) and the use of nephrotoxic medication were listed. In the first 3 months after BMT 17 (12%) patients died, 13 from transplant-related complications other than renal failure and four from relapse of the disease. Forty-eight children (34%) had a period with acute renal insufficiency. A high pre-BMT serum creatinine, transplantation with either a non-HLA-identical related or a matched unrelated donor were risk factors for acute renal insufficiency after BMT. Sepsis and the use of intravenous vancomycin were risk factors for acute renal insufficiency only for patients with a high pre-BMT serum creatinine. GVHD seemed to have a beneficial effect on renal function of BMT recipients. One year after BMT a total of 35 (25%) patients had died, 16 from transplant-related complications and 19 from relapse of the disease; another 17 patients could not be evaluated. Twenty-five of 90 evaluable children (28%) had chronic renal insufficiency. Chronic renal insufficiency 1 year after BMT was correlated with a high serum creatinine in the first 3 months after BMT. None of the children of this retrospective study on renal function after BMT needed dialysis. Keywords: bone marrow transplantation; child; renal insufficiency BMT has proven to be a good therapeutic approach for a wide range of hematologic, neoplastic, immunologic and Correspondence: Dr JE Kist-van Holthe, Department of Pediatrics, University Hospital Leiden, Postbus 9600, 2300 RC Leiden, The Netherlands Received 12 January 1998; accepted 7 May 1998 metabolic diseases. In the first 3 months post-BMT the transplant-related mortality rate approximates 10-20% in children. 1,2 The 5-year survival rate, dependent on the disease for which the bone marrow transplantation has been performed, varies from 90% for immunodeficiencies to 25% for hematologic malignancies in third remission. 1 The main steps of BMT are conditioning with intensive chemoradiotherapy to obtain engraftment of donor stem cells in the recipient, and prolonged immunosuppression to prevent GVHD. Major complications are (opportunistic) infections, GVHD and recurrence of primary disease. A major posttransplant complication that may contribute to transplantrelated mortality is acute renal insufficiency. 3,4 As BMT is the only curative therapy for some diseases, assessment of late complications becomes increasingly important. Understanding of the possible risk factors and the p...

“…It Four patients developed acute renal failure (ARF). ARF was defined, as previously described, 25 by at least a doubis noteworthy that 11 out of these patients were older than 50. No toxic deaths occurred among the 40 patients ling of baseline creatinine, assuming levels higher than 177 mmol/l (2 mg/dl).…”

Section: Patientsmentioning

confidence: 99%

Results of a pilot study of 40 patients using high-dose therapy with hematopoietic rescue after standard-dose adjuvant therapy for high-risk breast cancer

Tomás

Perez-Carrion

Escudero

et al. 1997

Summary:untreated patients shows little effect of adjuvant therapy in the first 4 years and only a modest statistically significant effect thereafter. 2 Thus, a trend toward a more aggressive The study was designed to determine the toxicity, feasibility, and effectiveness of high-dose cyclophosphamide approach for this subset of patients has occurred in the last years. (6 g/m 2 ), thiotepa (500 mg/m 2 ) and carboplatin (800 mg/m 2 ) (CTCb) with hematopoietic rescue as consoli-The dose intensity hypothesis has been the basis for most of these new treatment strategies. [3][4][5][6] Based on preclinical dation after standard-dose adjuvant chemotherapy treatment of primary high-risk breast cancer. From models which demonstrated a steep dose-response relationship for alkylating agents in breast cancer, 7,8 the use of October 1991 to September 1994, 40 patients with stage II or III breast cancer involving 10 or more nodes were high-dose chemotherapy (HDCT) with hemopoietic stem cell rescue has been broadly explored in selected patients treated with CTCb after six cycles of adjuvant therapy with an anthracycline-containing regimen. Bone marwith breast cancer in the last decade. To begin with, clinical trials were performed in the context of metastatic row (BM) was used as the source hematopoietic stem cell in the first 23 patients and G-CSF-mobilized periphdisease 9-11 but the availability of better support, as well as the current low mortality rates, have extended this approach eral blood progenitor cells (PBPC) in the other 17. No therapy-related deaths occurred, but three life-threatento patients with high-risk disease. The impact of this new indication for autologous blood or marrow transplantation ing complications were recorded which resolved: bilateral pulmonary hemorrhage, veno-occlusive disease of has become apparent, since 35% of all autologous transplants performed in the United States in 1994 were for the liver and pulmonary thromboembolism. PBPC result in faster hemopoietic reconstitution with signifibreast cancer. 12 Accordingly, questions as to efficacy, toxicity, and cost have beleaguered this new technology from cantly lower transfusion requirements. With a median follow-up of 35 months (23-59) actuarial event-free surthe start, and different randomized trials are currently under way. 13 Nevertheless, substantial controversy remains convival for the study patients at 3 years is 72% (CI 95%: 66-81%). Even in patients over 50-60 years, CTCb is cerning selection criteria defining the patient populations for which this therapy is the treatment of choice, in which a relatively well tolerated regimen which appears, after a median follow-up of nearly 3 years, to decrease others it remains investigational, and whether this therapy has been well enough developed for routine use in the adjurelapse frequency as compared with historical series, although a definite role of HDT in the treatment of highvant setting for high-risk patients. 14,15 Because of the above-mentioned adverse outcome with risk primary breast c...