Kidney Week

Abstract: FR-PO105

AKI and CKD after Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) – A Retrospective Analysis

Session Information

• AKI Clinical: Outcomes and Biomarkers
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Kirilova, Elena Kirilova, Uniklinik Dresden, Dresden, Germany

Elena Kirilova Kirilova,

• Kowald, Jan, University Hospital of Dresden, Dresden, Germany

Jan Kowald,

• Stölzel, Friedrich, Uniklinik Dresden, Dresden, Germany

Friedrich Stölzel,

• Bornhauser, Martin, University Hospital, Dresden, Germany

Martin Bornhauser,

• Hugo, Christian, University of Dresden, Dresden, Germany, Dresden, SN, Germany

Christian Hugo,

Background

Acute kidney injury is a common complication after HSCT and the procedure-related mortality rate increases with the stage of acute kidney injury. In the present study we assessed incidence and risk factors for acute kidney injury, chronic kidney disease and delta eGFR after HSCT.

Methods

In this retrospective study we included 312 patients which received allogeneic HSCT at our center between Jan. 2012 and Dec. 2014. The patients have been followed up until December 2016. We assessed Kidney function through documentated serum creatinine values. We evaluated the following risk factors before transplantation: age, co-morbidity index, previous CKD, diabetes mellitus, arterial hypertension, previous chemotherapy, conditioning regimens, stem cell source, HLA compatibility and relationship between donor and patient. Among the evaluated risk factors after transplantation were the complications: acute and chronic graft versus host disease, sepsis, cytomegalovirus reactivation, sinusoidal occlusive disease, immunosuppressive therapy, nephrotoxic medications and contrast medium.

Results

The incidence of acute kidney injury (AKI) amounts to 63.5 % (AKI stage 1: 27.8 %, AKI stage 2: 39.9 % and AKI stage 3: 32.3 %). Chronic kidney disease was found in 203 patients (65.1 %). 109 Patients (34.9%) did not show any signs of CKD. 127 patients (40.7%) from 203 patients with CKD after HSCT have developed CKD for the first time after HSCT. Multivariate analysis showed that CKD before HSCT and sepsis, contrast media and duration of the stay in an intensive care unit after HSCT were risk factors for AKI. Age, duration of the therapy with CsA and the count of acute kidney injuries were risk factors for chronic kidney disease in the multivariate analysis. Risk factors in the multivariate analysis for eGFR ≥ 15 ml/min/ 1.73 m² one year after HSCT were acute graft versus host disease and sepsis. Sepsis was the only risk factor in the multivariate analysis associated with mortality after HSCT.

Conclusion

AKI and CKD are common complications after HSCT. Sepsis was a universal risk factor in the multivariate analysis which was associated not only with kidney injury but also with excess mortality. The mortality rate after HSCT is high mostly in the first 6 months.