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Abstract: SA-PO150

AKI After Bone Marrow Transplantation

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Andronesi, Andreea, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
  • Sorohan, Bogdan, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
  • Burcea, Andreea, Fundeni Clinical Institute, Bucharest, Romania, Romania
  • Stanescu, Cristina, Fundeni Clinical Institute, Bucharest, Romania, Romania
  • Lupusoru, Gabriela, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
  • Andronesi, Danut, Fundeni Clinical Institute, Bucharest, Romania, Romania
  • Lupusoru, Mircea, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
  • Ismail, Gener, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
Background

Bone marrow transplantation (BMT) is the best therapeutic approach for an increasing number of blood disorders, as well as for some autoimmune diseases, offering the best disease-free survival in eligible patients. Acute kidney injury (AKI) is a serious complication, with significant impact upon outcomes, including progression to chronic kidney disease (CKD) and overall survival.

Methods

The aim was to evaluate the incidence, risk factors and severity of AKI during the first 100 days after BMT. We performed a prospective observational study. AKI definition and staging were done using KDIGO criteria. Renal recovery was defined as a reduction in serum creatinine within 0.3 mg/dl compared to baseline at 3 months after AKI. Cox regression analysis was used to identify independent risk factors for AKI.

Results

We included 405 consecutive patients- pts (203 F) with BMT- 240 auto-BMT and 165 allo-BMT. Pts with allo-BMT were significantly younger (mean age 57.8 years in auto-MBT, 39.3 years in allo-BMT, p=0.01). AKI incidence was 40.7%. The incidence (20.4% in auto-BMT, 70.3% in allo-BMT, p<0,001) and severity (in auto-BMT: AKI grade 1- 9.7%, grade 2- 0.5%, no grade 3 cases; in allo-BMT: grade 1- 36.7%, grade 2- 33.9%, grade 3- 47.2%, p=0.02) were significantly higher in allo-BMT. Emergency hemodialysis (HD) was initiated in 15 pts (3.7%), all with allo-BMT. Death was recorded exclusively in the allo-BMT. In allo-BMT, mortality during the first 100 days was 2.05 more frequent in the group of pts who developed AKI, but without statistical significance. The mortality in pts who required HD was very high- 85.5%. Renal recovery was recorded in 70.6% pts. In Cox regression analysis, allo-BMT (HR 9.01, CI 95% 3.1-34.3, p=0.001), preexisting CKD (HR 5.5, 95%CI: 2.4-19.2, p=0.002), and calcineurin inhibitors (CNI) overdosage (HR 2.3, CI 95% 1.1-3.2, p=0.003) were independent risk factors for AKI, while sepsis was the only independent risk factor for AKI stage 3 (HR= 5.1, CI 95% 1.9-17.5, p=0.003).

Conclusion

AKI occurs with reduced incidence and severity after auto-BMT and does not have impact upon survival. AKI after allo-BMT is much more severe and has a significant impact upon outcome. A better fluid management, avoidance of the nehrotoxins especially in preexisting CKD, and carefully monitoring of CNI may significant reduce this risk.