Need for hemodialysis in patients undergoing hematopoietic stem cell transplantation: risk factors and survival in a retrospective cohort

Chapchap, Eduardo Cerello; Doher, Marisa Petrucelli; Kerbauy, Lucila Nassif; Belucci, Talita Rantin; Santos, Fábio Pires de Souza; Ribeiro, Andreza Alice Feitosa; Hamerschlak, Nelson

doi:10.1016/j.htct.2022.04.005

Cited by 4 publications

(3 citation statements)

References 21 publications

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“… 20 Most recently, a cohort analysis conducted by Chapchap et al found a 17.6% 1-year cumulative incidence of hemodialysis requirements, with progression to dialysis associated with male sex and age. 21 Here, male patients showed a higher incidence of 14.88% compared with 9.74% in female patients. The cumulative incidence of postprocedure AKI was 13.7% in our study, consistent with data that analyzes AKI incidence 30 days after HSCT instead of 100 days after.…”

Section: Discussionmentioning

confidence: 68%

Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients

Ashruf,

Orozco

et al. 2024

Kidney360

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Key Points The cumulative incidence of AKI diagnosis post–hematopoietic stem cell transplantation was 12.9%. Calcineurin inhibitor use was associated with the highest cumulative incidence, 21.6%, after hematopoietic stem cell transplantation.Patients with AKI with hypertension/hypertensive disease had a 30-day survival probability of 63.9% (hazard ratio, 4.86, 95% confidence interval, 3.58 to 6.60).Patients with AKI were 2.5 times more likely to experience composite hospitalization and/or mortality at 30 days. Of patients who developed AKI, dialysis dependence has nearly tripled since 2014. Background AKI is a common complication in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT), with a reported prevalence ranging from 68% to 84%. Few multicenter pediatric studies comprehensively assess the epidemiologic associations and clinical outcomes associated with AKI development. Methods An observational, retrospective analysis was conducted using an aggregated electronic health record data platform. The study population consisted of pediatric patients (age <18 years) who underwent HSCT over a 20-year period. The study groups consisted of patients with an encounter diagnosis of AKI (n=713) and those without AKI (n=4455). Both groups were propensity matched for age, sex, race, prior cancer diagnosis, and other comorbidities. End points were incidence, mortality risk, clinical outcomes, and prevalence of dialysis dependence. Competing risks analysis, Cox proportional hazard analyses, Kaplan–Meier survival curves, and incidence/prevalence rates were calculated. Results After matching, 688 patients were identified. Cumulative incidence of AKI diagnosis post-HSCT was 13.7%. Hypertensive disease, calcineurin inhibitors, and vancomycin were the most prevalent risk factors for AKI, with calcineurin inhibitors showing the highest cumulative incidence (21.6%). Patients with AKI with hypertensive disease had a survival probability of 63.9% at 30 days, followed by calcineurin inhibitors (64.4%) and vancomycin (65.9%). Patients with AKI were 1.7 times more likely to experience composite hospitalization and/or mortality at 30 days. At 365 days post-HSCT, patients with AKI had higher rates of all-cause emergency department visits, intensive care unit admissions, and mechanical ventilation compared with non-AKI. Of patients who developed AKI, the prevalence of dialysis dependence has nearly tripled since 2014. Conclusions The findings highlight a strong association between specific risk factors, such as hypertension, calcineurin inhibitor use, and vancomycin use, with increased mortality and adverse clinical outcomes in patients with AKI after HSCT. These results emphasize the need for preventative actions such as 24-hour BP monitoring and discontinuation of potential nephrotoxic medications.

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Section: Discussionmentioning

confidence: 68%

Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients

Ashruf,

Orozco

et al. 2024

Kidney360

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“…Therefore, it seems reasonable to ensure regular check-ups for both current and previous diseases in order to effectively control them, but at the same time avoid burdensome side effects [ 16 ]. Due to the significant nephrotoxicity of the drugs in common use, especially calcineurin inhibitors, irreversibly deteriorating kidney function may require proper management including hemodialysis followed by kidney transplantation [ 17 ]. The presented case gives a clear example of rapidly developed renal dysfunction following the administration of Tac, as indicated by its exceeded blood level, far beyond the therapeutic index (TI).…”

Section: Discussionmentioning

confidence: 99%

“…Data obtained from studies with pediatric population indicated the benefits of early implementation of balanced fluid therapy and hemodialysis [ 25 , 26 ]. However, as another study showed, hemodialysis in patients after allo-HSCT can be associated with a high mortality rate [ 17 ]. In studies involving children who had received allo-HSCT, the survival rate was higher in patients with convective therapy (continuous venovenous hemofiltration or hemodiafiltration) than among those with diffusion therapy (dialysis) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Double Malignancy and Double Transplant—A Bumpy Road to Success

et al. 2023

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The occurrence of secondary neoplasms in adult patients treated with chemotherapy in childhood is not uncommon. Prior chemotherapy is found to be an independent risk factor for the development of secondary malignancies, which are usually associated with a worse prognosis. The presented case is a 35-year-old female patient who was diagnosed with Ewing sarcoma in her late adolescence. The tumor was successfully treated with chemotherapy, but 3 years later she was diagnosed with T-cell lymphoblastic lymphoma. The patient received allogeneic hematopoietic stem cell transplantation (allo-HSCT) from human leukocyte antigen (HLA) matched related donor. The procedure was complicated by grade 2 acute graft-versus-host disease (GvHD) which resolved after implementation of immunosuppressive treatment. However, a year later, the patient developed extensive chronic GvHD (cGvHD) and required reintroduction of immunosuppressants. Prolonged immunosuppressive treatment with tacrolimus led to irreversible kidney failure. After a 2-year period of regular peritoneal dialysis, she was found to be eligible for a kidney transplant from a deceased donor. Now, 15 years after stem cell transplantation and 8 years after kidney transplantation, the patient remains in good condition overall, presenting with symptoms of limited cGvHD. The case described here presents a unique clinical scenario of a female patient who was successfully treated for her double malignancy. Moreover, she underwent effective double transplantations and was eventually found to be cured despite accompanying complications.

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Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement

Nardo

MacLaren

Schellongowski

et al. 2023

The Lancet Respiratory Medicine

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Need for hemodialysis in patients undergoing hematopoietic stem cell transplantation: risk factors and survival in a retrospective cohort

Cited by 4 publications

References 21 publications

Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients

Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients

Double Malignancy and Double Transplant—A Bumpy Road to Success

Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement

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