Risk factors for severe acute kidney injury after pediatric hematopoietic cell transplantation.

Autor: Bauer A; Division of Nephrology, Department of Pediatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97238, USA. baueab@ohsu.edu., Carlin K; Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, USA., Schwartz SM; Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA.; Epidemiology Program, Fred Hutchinson Cancer Center, Seattle, USA., Srikanthan M; Division of Hematology Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, USA., Thakar M; Division of Hematology Oncology, Department of Pediatrics, Fred Hutchinson Cancer Center, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, USA., Burroughs LM; Division of Hematology Oncology, Department of Pediatrics, Fred Hutchinson Cancer Center, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, USA., Smith J; Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, USA., Hingorani S; Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, USA., Menon S; Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, USA.
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2023 Apr; Vol. 38 (4), pp. 1365-1372. Date of Electronic Publication: 2022 Sep 20.
DOI: 10.1007/s00467-022-05731-x
Abstrakt: Background: Acute kidney injury (AKI) is common after hematopoietic cell transplantation (HCT) and is associated with poorer outcomes. Risk factors for AKI after pediatric HCT are not fully understood. The study objective was to assess unique risk factors for AKI in the HCT population and evaluate post-HCT AKI patterns.
Methods: We conducted a retrospective cohort study of patients < 21 years of age who underwent HCT at Seattle Children's Hospital/Fred Hutchinson Cancer Center from September 2008 to July 2017 (n = 484). We defined AKI using KDIGO criteria. We collected demographics, baseline HCT characteristics, post-HCT complications, and mortality. Multinomial logistic regression was used to estimate association between AKI and potential risk factors. We used adjusted Cox proportional hazard ratios to evaluate differences in mortality.
Results: One hundred and eighty-six patients (38%) developed AKI. Seventy-nine (42%) had severe AKI and 27 (15%) required kidney replacement therapy. Fluid overload was common in all groups and 67% of those with severe AKI had > 10% fluid overload. Nephrology was consulted in less than 50% of those with severe AKI. In multivariable analysis, risk of severe AKI was lower in those taking a calcineurin inhibitor (CNI). Risk of death was higher in severe AKI compared to no AKI (RR 4.6, 95% CI 2.6-8.1).
Conclusions: AKI and fluid overload are common in pediatric patients after HCT. Severe AKI occurred less often with CNI use and was associated with higher mortality. Future interventions to reduce AKI and its associated complications such as fluid overload are approaches to reducing morbidity and mortality after HCT. A higher resolution version of the Graphical abstract is available as Supplementary information.
(© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
Databáze: MEDLINE
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