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Abstract: FR-PO094

AKI in Patients With Leukemia Submitted to Allogeneic Hematopoietic Stem Cell Transplant: A Cohort Analysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Costa, Claudia, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Rodrigues, Natacha, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Branco, Carolina, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Marques, Filipe, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Vasconcelos, Pedro De, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Martins, Carlos Manuel Varela, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Lopes, Jose António, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
Background

Studies on acute kidney injury (AKI) in hematopoietic stem cell transplant (HSCT) consider several hematologic diagnoses in their cohorts and heterogeneous definitions for AKI. The purpose of this study was to evaluate the incidence, severity, and risk factors of AKI in patients with leukemia submitted to allogeneic HSCT considering serum creatinine (SCr) and UO.

Methods

We conducted a single-center retrospective cohort study including 164 patients with leukemia admitted for allogeneic HSCT between 2005 and 2015. KDIGO classification was used for AKI diagnosis considering daily values of SCr and 6-hour UO from admission day for HSCT until hospital discharge, and weekly evaluations within the first 100 days. We used survival analysis methods considering competing events to calculate AKI cumulative incidence, to stablish AKI risk factors and to evaluate AKI impact on relapse, and Cox regression for AKI impact on 5-year mortality.

Results

The cumulative incidence of AKI was 58.5% at 30 days post-HSCT and 63.4% at 100 days post-HSCT. AKI diagnosis was firstly made by SCr criteria in 76.9%, by UO criteria in 15.4% and by both in 7.7%. The highest stage of AKI was 1 in 61.8%, 2 in 21.6% and 3 in 16.7%. Renal replacement therapy occurred in 12.5%. Independent variables associated with higher incidence of AKI included: hematopoietic cell transplant-specific comorbidity index (HCT-CI)>2 (Hazard Ratio (HR)1.88, 95%CI 1.13-3.11,p=0.015), radiotherapy (RT) in the past (HR 2.07,95%CI 2.07-1.06,p=0.034), serum lactate dehydrogenase (LDH) at hospital admission (HR 1.51, 95%CI,1.03-2.21,p=0.035), shock (HR 1.57,95%CI 1.02-2.39,p=0.039), and sepsis (HR 3.36, 95%CI 1.22-9.24,p=0.019). AKI was an independent risk factor for 5-year mortality (HR 1.67,95% CI 1.09-2.57,p=0.020).

Conclusion

AKI affects almost two thirds of leukemia patients submitted to allogeneic HSCT. Independent risk factors for AKI were HCT-CI >2, previous RT, higher LDH levels at hospital admission, sepsis, and shock. AKI was independently associated with 5-year mortality. To our knowledge, this is the first study considering both SCr and UO criteria for AKI classification in leukemia patients after HSCT, which contributes to a more accurate determination of AKI incidence in these patients.