Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation
Background and objectives AKI is a major complication of allogeneic hematopoietic stem cell transplantation, increasing risk of nonrelapse mortality. AKI etiology is often ambiguous due to heterogeneity of conditioning/graft versus host disease regimens. To date, graft versus host disease and calcin...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2021-09, Vol.16 (9), p.1318-1327 |
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| creator | Abramson, Matthew H. Gutgarts, Victoria Zheng, Junting Maloy, Molly A. Ruiz, Josel D. Scordo, Michael Jaimes, Edgar A. Sathick, Insara Jaffer |
| description | Background and objectives AKI is a major complication of allogeneic hematopoietic stem cell transplantation, increasing risk of nonrelapse mortality. AKI etiology is often ambiguous due to heterogeneity of conditioning/graft versus host disease regimens. To date, graft versus host disease and calcineurin inhibitor effects on AKI are not well defined. We aimed to describe AKI and assess pre?/post?hematopoietic transplant risk factors in a large recent cohort.
Design, setting, participants, & measurements We performed a single-center, retrospective study of 616 allogeneic hematopoietic cell transplant recipients from 2014 to 2017. We defined AKI and CKD based on Kidney Disease Improving Global Outcomes (KDIGO) criteria and estimated GFR using the Chronic Kidney Disease Epidemiology Collaboration equation. We assessed AKI pre?/post?hematopoietic transplant risk factors using cause-specific Cox regression and association of AKI with CKD outcomes using chi-squared test. AKI was treated as a time-dependent variable in relation to nonrelapse mortality.
Results Incidence of AKI by day 100 was 64%. Exposure to tacrolimus and other nephrotoxins conferred a higher risk of AKI, but tacrolimus levels were not associated with severity. Reduced-intensity conditioning carried higher AKI risk compared with myeloablative conditioning. Most stage 3 AKIs were due to ischemic acute tubular necrosis and calcineurin inhibitor nephrotoxicity. KRT was initiated in 21 out of 616 patients (3%); of these 21 patients, nine (43%) recovered and five (24%) survived to hospital discharge. T cell?depleted transplants, higher baseline serum albumin, and non-Hispanic ethnicity were associated with lower risk of AKI. CKD developed in 21% (73 of 345) of patients after 12 months. Nonrelapse mortality was higher in those with AKI (hazard ratio, 2.77; 95% confidence interval, 1.8 to 4.27).
Conclusions AKI post?hematopoietic cell transplant remains a major concern. Risk of AKI was higher with exposure to calcineurin inhibitors. T cell?depleted hematopoietic cell transplants and higher serum albumin had lower risk of AKI. Of the patients requiring KRT, 43% recovered kidney function.
Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN19801220.mp3 |
| doi_str_mv | 10.2215/CJN.19801220 |
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| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_2215_CJN_19801220</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>34135023</sourcerecordid><originalsourceid>FETCH-LOGICAL-c450t-61f9c97ba3a323c1d65a76b63ec1b28577220cd44d4ef66c2a64dd9fab2d8c0d3</originalsourceid><addsrcrecordid>eNqNkEtLAzEURoMovneuJXttzXMeG6EM1dbnQgXBxZBJ7rSRaVIyqdJ_75Rq0Z2r3JDzfZcchE4o6TNG5UVx89CneUYoY2QL7VMpZS8n8nV7Mwu6hw7a9p0QITiTu2iPC8olYXwfvQ30IgK-tcbBEo_d-yIssXU4TgHfewPB4WFQ2Nd40DR-Ag6sxiOYqejn3kLsbk8RZriApsHPQbl23igXVbTeHaGdWjUtHH-fh-jlavhcjHp3j9fjYnDX00KS2Etones8rRRXnHFNTSJVmlQJB00rlsk07X6mjRBGQJ0kmqlEGJPXqmIm08TwQ3S57p0vqhkYDS4G1ZTzYGcqLEuvbPn3xdlpOfEfZZayXGa0KzhfF-jg2zZAvclSUq4kl53k8kdyh5_-3reBf6x2QLYGPqHydastOA0bjBCScpFwwchqLOzaVuEXLnbRs_9H-Red_poJ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Abramson, Matthew H. ; Gutgarts, Victoria ; Zheng, Junting ; Maloy, Molly A. ; Ruiz, Josel D. ; Scordo, Michael ; Jaimes, Edgar A. ; Sathick, Insara Jaffer</creator><creatorcontrib>Abramson, Matthew H. ; Gutgarts, Victoria ; Zheng, Junting ; Maloy, Molly A. ; Ruiz, Josel D. ; Scordo, Michael ; Jaimes, Edgar A. ; Sathick, Insara Jaffer</creatorcontrib><description>Background and objectives AKI is a major complication of allogeneic hematopoietic stem cell transplantation, increasing risk of nonrelapse mortality. AKI etiology is often ambiguous due to heterogeneity of conditioning/graft versus host disease regimens. To date, graft versus host disease and calcineurin inhibitor effects on AKI are not well defined. We aimed to describe AKI and assess pre?/post?hematopoietic transplant risk factors in a large recent cohort.
Design, setting, participants, & measurements We performed a single-center, retrospective study of 616 allogeneic hematopoietic cell transplant recipients from 2014 to 2017. We defined AKI and CKD based on Kidney Disease Improving Global Outcomes (KDIGO) criteria and estimated GFR using the Chronic Kidney Disease Epidemiology Collaboration equation. We assessed AKI pre?/post?hematopoietic transplant risk factors using cause-specific Cox regression and association of AKI with CKD outcomes using chi-squared test. AKI was treated as a time-dependent variable in relation to nonrelapse mortality.
Results Incidence of AKI by day 100 was 64%. Exposure to tacrolimus and other nephrotoxins conferred a higher risk of AKI, but tacrolimus levels were not associated with severity. Reduced-intensity conditioning carried higher AKI risk compared with myeloablative conditioning. Most stage 3 AKIs were due to ischemic acute tubular necrosis and calcineurin inhibitor nephrotoxicity. KRT was initiated in 21 out of 616 patients (3%); of these 21 patients, nine (43%) recovered and five (24%) survived to hospital discharge. T cell?depleted transplants, higher baseline serum albumin, and non-Hispanic ethnicity were associated with lower risk of AKI. CKD developed in 21% (73 of 345) of patients after 12 months. Nonrelapse mortality was higher in those with AKI (hazard ratio, 2.77; 95% confidence interval, 1.8 to 4.27).
Conclusions AKI post?hematopoietic cell transplant remains a major concern. Risk of AKI was higher with exposure to calcineurin inhibitors. T cell?depleted hematopoietic cell transplants and higher serum albumin had lower risk of AKI. Of the patients requiring KRT, 43% recovered kidney function.
Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN19801220.mp3</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.19801220</identifier><identifier>PMID: 34135023</identifier><language>eng</language><publisher>WASHINGTON: Amer Soc Nephrology</publisher><subject>Acute Kidney Injury - epidemiology ; Acute Kidney Injury - etiology ; Adult ; Aged ; Female ; Hematopoietic Stem Cell Transplantation - adverse effects ; Humans ; Life Sciences & Biomedicine ; Male ; Middle Aged ; Original ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Retrospective Studies ; Risk Factors ; Science & Technology ; Urology & Nephrology ; Young Adult</subject><ispartof>Clinical journal of the American Society of Nephrology, 2021-09, Vol.16 (9), p.1318-1327</ispartof><rights>Copyright © 2021 by the American Society of Nephrology.</rights><rights>Copyright © 2021 by the American Society of Nephrology 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>21</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000734634200007</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c450t-61f9c97ba3a323c1d65a76b63ec1b28577220cd44d4ef66c2a64dd9fab2d8c0d3</citedby><cites>FETCH-LOGICAL-c450t-61f9c97ba3a323c1d65a76b63ec1b28577220cd44d4ef66c2a64dd9fab2d8c0d3</cites><orcidid>0000-0002-7805-2287</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8729581/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8729581/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,729,782,786,887,27931,27932,39265,53798,53800</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34135023$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abramson, Matthew H.</creatorcontrib><creatorcontrib>Gutgarts, Victoria</creatorcontrib><creatorcontrib>Zheng, Junting</creatorcontrib><creatorcontrib>Maloy, Molly A.</creatorcontrib><creatorcontrib>Ruiz, Josel D.</creatorcontrib><creatorcontrib>Scordo, Michael</creatorcontrib><creatorcontrib>Jaimes, Edgar A.</creatorcontrib><creatorcontrib>Sathick, Insara Jaffer</creatorcontrib><title>Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>CLIN J AM SOC NEPHRO</addtitle><addtitle>Clin J Am Soc Nephrol</addtitle><description>Background and objectives AKI is a major complication of allogeneic hematopoietic stem cell transplantation, increasing risk of nonrelapse mortality. AKI etiology is often ambiguous due to heterogeneity of conditioning/graft versus host disease regimens. To date, graft versus host disease and calcineurin inhibitor effects on AKI are not well defined. We aimed to describe AKI and assess pre?/post?hematopoietic transplant risk factors in a large recent cohort.
Design, setting, participants, & measurements We performed a single-center, retrospective study of 616 allogeneic hematopoietic cell transplant recipients from 2014 to 2017. We defined AKI and CKD based on Kidney Disease Improving Global Outcomes (KDIGO) criteria and estimated GFR using the Chronic Kidney Disease Epidemiology Collaboration equation. We assessed AKI pre?/post?hematopoietic transplant risk factors using cause-specific Cox regression and association of AKI with CKD outcomes using chi-squared test. AKI was treated as a time-dependent variable in relation to nonrelapse mortality.
Results Incidence of AKI by day 100 was 64%. Exposure to tacrolimus and other nephrotoxins conferred a higher risk of AKI, but tacrolimus levels were not associated with severity. Reduced-intensity conditioning carried higher AKI risk compared with myeloablative conditioning. Most stage 3 AKIs were due to ischemic acute tubular necrosis and calcineurin inhibitor nephrotoxicity. KRT was initiated in 21 out of 616 patients (3%); of these 21 patients, nine (43%) recovered and five (24%) survived to hospital discharge. T cell?depleted transplants, higher baseline serum albumin, and non-Hispanic ethnicity were associated with lower risk of AKI. CKD developed in 21% (73 of 345) of patients after 12 months. Nonrelapse mortality was higher in those with AKI (hazard ratio, 2.77; 95% confidence interval, 1.8 to 4.27).
Conclusions AKI post?hematopoietic cell transplant remains a major concern. Risk of AKI was higher with exposure to calcineurin inhibitors. T cell?depleted hematopoietic cell transplants and higher serum albumin had lower risk of AKI. Of the patients requiring KRT, 43% recovered kidney function.
Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN19801220.mp3</description><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - etiology</subject><subject>Adult</subject><subject>Aged</subject><subject>Female</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Science & Technology</subject><subject>Urology & Nephrology</subject><subject>Young Adult</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkEtLAzEURoMovneuJXttzXMeG6EM1dbnQgXBxZBJ7rSRaVIyqdJ_75Rq0Z2r3JDzfZcchE4o6TNG5UVx89CneUYoY2QL7VMpZS8n8nV7Mwu6hw7a9p0QITiTu2iPC8olYXwfvQ30IgK-tcbBEo_d-yIssXU4TgHfewPB4WFQ2Nd40DR-Ag6sxiOYqejn3kLsbk8RZriApsHPQbl23igXVbTeHaGdWjUtHH-fh-jlavhcjHp3j9fjYnDX00KS2Etones8rRRXnHFNTSJVmlQJB00rlsk07X6mjRBGQJ0kmqlEGJPXqmIm08TwQ3S57p0vqhkYDS4G1ZTzYGcqLEuvbPn3xdlpOfEfZZayXGa0KzhfF-jg2zZAvclSUq4kl53k8kdyh5_-3reBf6x2QLYGPqHydastOA0bjBCScpFwwchqLOzaVuEXLnbRs_9H-Red_poJ</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Abramson, Matthew H.</creator><creator>Gutgarts, Victoria</creator><creator>Zheng, Junting</creator><creator>Maloy, Molly A.</creator><creator>Ruiz, Josel D.</creator><creator>Scordo, Michael</creator><creator>Jaimes, Edgar A.</creator><creator>Sathick, Insara Jaffer</creator><general>Amer Soc Nephrology</general><general>American Society of Nephrology</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7805-2287</orcidid></search><sort><creationdate>20210901</creationdate><title>Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation</title><author>Abramson, Matthew H. ; Gutgarts, Victoria ; Zheng, Junting ; Maloy, Molly A. ; Ruiz, Josel D. ; Scordo, Michael ; Jaimes, Edgar A. ; Sathick, Insara Jaffer</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c450t-61f9c97ba3a323c1d65a76b63ec1b28577220cd44d4ef66c2a64dd9fab2d8c0d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - etiology</topic><topic>Adult</topic><topic>Aged</topic><topic>Female</topic><topic>Hematopoietic Stem Cell Transplantation - adverse effects</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Science & Technology</topic><topic>Urology & Nephrology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abramson, Matthew H.</creatorcontrib><creatorcontrib>Gutgarts, Victoria</creatorcontrib><creatorcontrib>Zheng, Junting</creatorcontrib><creatorcontrib>Maloy, Molly A.</creatorcontrib><creatorcontrib>Ruiz, Josel D.</creatorcontrib><creatorcontrib>Scordo, Michael</creatorcontrib><creatorcontrib>Jaimes, Edgar A.</creatorcontrib><creatorcontrib>Sathick, Insara Jaffer</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abramson, Matthew H.</au><au>Gutgarts, Victoria</au><au>Zheng, Junting</au><au>Maloy, Molly A.</au><au>Ruiz, Josel D.</au><au>Scordo, Michael</au><au>Jaimes, Edgar A.</au><au>Sathick, Insara Jaffer</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><stitle>CLIN J AM SOC NEPHRO</stitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>16</volume><issue>9</issue><spage>1318</spage><epage>1327</epage><pages>1318-1327</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>Background and objectives AKI is a major complication of allogeneic hematopoietic stem cell transplantation, increasing risk of nonrelapse mortality. AKI etiology is often ambiguous due to heterogeneity of conditioning/graft versus host disease regimens. To date, graft versus host disease and calcineurin inhibitor effects on AKI are not well defined. We aimed to describe AKI and assess pre?/post?hematopoietic transplant risk factors in a large recent cohort.
Design, setting, participants, & measurements We performed a single-center, retrospective study of 616 allogeneic hematopoietic cell transplant recipients from 2014 to 2017. We defined AKI and CKD based on Kidney Disease Improving Global Outcomes (KDIGO) criteria and estimated GFR using the Chronic Kidney Disease Epidemiology Collaboration equation. We assessed AKI pre?/post?hematopoietic transplant risk factors using cause-specific Cox regression and association of AKI with CKD outcomes using chi-squared test. AKI was treated as a time-dependent variable in relation to nonrelapse mortality.
Results Incidence of AKI by day 100 was 64%. Exposure to tacrolimus and other nephrotoxins conferred a higher risk of AKI, but tacrolimus levels were not associated with severity. Reduced-intensity conditioning carried higher AKI risk compared with myeloablative conditioning. Most stage 3 AKIs were due to ischemic acute tubular necrosis and calcineurin inhibitor nephrotoxicity. KRT was initiated in 21 out of 616 patients (3%); of these 21 patients, nine (43%) recovered and five (24%) survived to hospital discharge. T cell?depleted transplants, higher baseline serum albumin, and non-Hispanic ethnicity were associated with lower risk of AKI. CKD developed in 21% (73 of 345) of patients after 12 months. Nonrelapse mortality was higher in those with AKI (hazard ratio, 2.77; 95% confidence interval, 1.8 to 4.27).
Conclusions AKI post?hematopoietic cell transplant remains a major concern. Risk of AKI was higher with exposure to calcineurin inhibitors. T cell?depleted hematopoietic cell transplants and higher serum albumin had lower risk of AKI. Of the patients requiring KRT, 43% recovered kidney function.
Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN19801220.mp3</abstract><cop>WASHINGTON</cop><pub>Amer Soc Nephrology</pub><pmid>34135023</pmid><doi>10.2215/CJN.19801220</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7805-2287</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Kidney Injury - epidemiology Acute Kidney Injury - etiology Adult Aged Female Hematopoietic Stem Cell Transplantation - adverse effects Humans Life Sciences & Biomedicine Male Middle Aged Original Postoperative Complications - epidemiology Postoperative Complications - etiology Retrospective Studies Risk Factors Science & Technology Urology & Nephrology Young Adult |
| title | Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation |
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