Abstract: SA-PO1261
Incidence, Predictors, and Outcomes of Tumor Lysis Syndrome-Associated AKI Requiring Dialysis in Hospitalized Patients with Diffuse Large B-Cell Lymphoma
Session Information
- Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Francis, Lydia, Southeast Health, Dothan, Alabama, United States
- Easow, Benjamin M., Southeast Health, Dothan, Alabama, United States
- Jiby, Sandhra, Dr Somervell Memorial CSI Medical College and Hospital, Thiruvananthapuram, KL, India
- Sivakumar, Abinaya, Southeast Health, Dothan, Alabama, United States
- Kodavanti, Chandra Kumar Mallick, Southeast Health, Dothan, Alabama, United States
Background
Diffuse large B-cell lymphoma (DLBCL) is among the hematologic malignancies at highest risk for tumor lysis syndrome (TLS), driven by its high proliferative index and large tumor burden. TLS occurs when rapid cell death - typically triggered by chemotherapy initiation floods the circulation with uric acid, potassium, and phosphate, overwhelming renal clearance. When the resulting AKI progresses to require dialysis, it signals severe metabolic compromise, often layered with electrolyte emergencies and concurrent sepsis. National data on this complication in DLBCL are lacking.
Methods
We analyzed the 2022–2023 National Inpatient Sample (NIS). Adult hospitalizations with DLBCL (ICD-10-CM C83.3x) were included. TLS (E88.3), AKI (N17.x), and dialysis (ICD-10-PCS 5A1D) were identified by diagnosis and procedure codes. Survey-weighted logistic regression estimated aOR for TLS-AKI-dialysis, adjusting for age, sex, insurance, income quartile, CKD, diabetes, heart failure, and sepsis.
Results
We identified 146,520 weighted DLBCL hospitalizations (29,304 unweighted). TLS occurred in 3.7%, AKI in 23.2%, and TLS-associated AKI requiring dialysis in 0.53%. Despite its low incidence, this complication carried devastating outcomes: inpatient mortality 53.2% vs. 5.5% in those without (p<0.001), mean LOS 18.0 vs. 8.3 days, and mean charges $454,227 vs. $167,185. Among patients with TLS+AKI, dialysis requirement further stratified mortality to 53.2% vs. 22.4%, reflecting the severity gradient within this syndrome. The strongest independent predictor was concurrent sepsis (aOR 5.49, 95% CI 3.90–7.73, p<0.001), consistent with the compounding insult of simultaneous cytokine storm and metabolic crisis. Pre-existing CKD independently doubled the risk (aOR 2.14, 95% CI 1.45–3.17, p<0.001), underscoring limited renal reserve as a key vulnerability at treatment initiation.
Conclusion
TLS-associated AKI requiring dialysis affects fewer than 1% of hospitalized DLBCL patients but carries a 53% inpatient mortality and nearly triples healthcare charges. The dominant role of CKD and sepsis as predictors highlights the importance of early risk stratification particularly for patients with baseline renal impairment to guide preemptive TLS prophylaxis, aggressive IV hydration, rasburicase use, and early nephrology co-management at the time of lymphoma treatment initiation.