Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients

Abstract

Acute kidney injury (AKI) following stem-cell transplantation (SCT) contributes to a poor prognosis, yet its impact may vary depending on the timing of AKI onset. A prospective cohort study was performed to understand the significance of the onset timing in 103 allogeneic SCT (allo-SCT) recipients. AKI prior to stem-cell engraftment was defined as early AKI and subsequently occurring AKI as late AKI. Propensity score (PS) for early AKI was calculated using a logistic regression model to reduce confounding effects related to differences in clinical background between the early and late AKI groups. The cumulative incidences of early and late AKI were 22.3% and 54.9%, respectively. Non-relapse mortality (NRM) was 39.1% and 7.0%, and overall survival (OS) was 56.5% and 90.9% in early and late AKI at 100 days after AKI, respectively (Po 0.001). The cumulative incidence of chronic kidney disease (CKD) over 2 years after SCT was 41.5% and 19.1% in early and late AKI, respectively (P = 0.048). Logistic regression analysis adjusted for the PS showed that early AKI was significantly associated with OS (odds ratio (95% confidence interval); 4.63 (1.15-21.4), P = 0.031) but with neither NRM (1.25 (0.28-5.33), P = 0.766) nor CKD (1.85 (0.41-8.60), P = 0.422). In conclusion, early AKI may portend a poor survival for allo-SCT recipients.

Risk Factors for Acute Kidney Injury and Chronic Kidney Disease following Allogeneic Hematopoietic Stem Cell Transplantation for Hematopoietic Malignancies

“…Acta Haematol 2020;143:452-464 DOI: 10.1159/000504354 survival (OS) [3][4][5]. Early-onset AKI (within 100 days of transplantation) has been reported to be a particularly unfavorable prognostic factor [6]. Suggested risk factors for AKI following allo-HSCT include septicemia, sinusoidal obstruction syndrome (SOS), thrombotic microangiopathy (TMA), total body irradiation (TBI), and nephrotoxic drugs, such as calcineurin inhibitors (CNIs) and amphotericin B (AMPH-B).…”

An Overview of Kidney Disease Following Hematopoietic Cell Transplantation

“…Accordingly, the avoidance and management of factors associated with mortality are pivotal for improving the survival rates. In allogeneic but not autologous SCT, nephrologists have noted that the development of AKI early after SCT was closely associated with an increased mortality rate in the early phase ( 7 , 8 , 20 , 21 ). Thus, hematologists committed to SCT need to obtain a clearer understanding of current concepts and diagnostic criteria for AKI, monitor changes in laboratory data related to kidney disease, and consult a nephrologist as soon as AKI is suspected.…”

Renal Complications after Hematopoietic Stem Cell Transplantation: Role of Graft-Versus-Host Disease in Renal Thrombotic Microangiopathy

“…Cases of long-term survival are increasing with improvements in transplantation techniques; however, renal disorders that complicate the late stages after transplantation often progress to end-stage renal failure, which may lead to renal replacement therapy 3,4 . Furthermore, renal complications increase morbidity and mortality rates 5 . We recently reported that renal thrombotic microangiopathy (TMA) is associated with chronic graft-versushost disease (GVHD) 6 8 .…”