Risk factors for acute kidney injury in patients undergoing allogeneic hematopoietic stem cell transplantation

作     者：Zheng-Ping Yu Jia-Hua Ding Bao-An Chen Bi-Cheng Liu Hong Liu Yu-Feng Li Bang-He Ding Jun Qian 

作者机构：Department of Hematology and Hematopoietic Cell Transplantation Zhongda Hospital Southeast University School of Medicine Nanjing Jiangsu 210009 P. R. China Institute of Nephrology Zhongda Hospital Southeast University School of Medicine Nanjing Jiangsu 210009 P. R. China Hematology Division Huaian Hospital Nanjing Medical University Huaian Jiangsu 223300 P. R. China Hematology Division Zhenjiang Hospital Zhenjiang Medical University Zhenjiang Jiangsu 212002 P. R. China 

出 版 物：《Chinese Journal of Cancer》 (CHINESE JOURNAL OF CANCER)

年 卷 期：2010年第29卷第11期

页      面：946-951页

核心收录：

学科分类：0710[理学-生物学] 1002[医学-临床医学] 07[理学] 08[工学] 071009[理学-细胞生物学] 09[农学] 0901[农学-作物学] 0836[工学-生物工程] 090102[农学-作物遗传育种] 

主　　题：异基因造血干细胞移植 风险因素 移植治疗 肾损伤 患者 急性 肾功能不全 血清肌酐 

摘      要：Background and Objective: Allogeneic hematopoietic cell transplantation (allo-HSCT) is a potent procedure for the treatment of hematologic diseases, yet it is associated with high risks of treatment-related complications. Except for transplant-related organ toxicities, renal insufficiencies which emerge earlier significantly limit patients long survival. To analyze risk factors for acute kidney injury (AKI), we conducted a retrospective cohort study of 96 patients undergoing HSCT. Methods: During the first 100 days after allo-HSCT, all patients were evaluated for renal function by measuring serum creatinine clearance and glomerular filtration rate (GFR) with a classification below: Grade 0 ( 25%, decline in creatinine clearance), Grade 1 ( ≥25% decline in creatinine clearance but 2-fold increase in serum creatinine), Grade 2 ( ≥2-fold rise in serum creatinine but no need for dialysis), and Grade 3 ( ≥2-fold rise in serum creatinine and need for dialysis). Cox regression model was used to calculate the hazard ratios (HRs) of demographic data, clinical variables, and risk factors for AKI. Results: Twenty-eight (29.2%) patients occurred Grades 1-3 renal dysfunction (Grade 1, 14 patients; Grade 2, 12 patients; Grade 3, 2 patients), and ratios of early kidney injury increased in high-risk malignancy group (HR = 2.945, 95% confidence interval (CI) = 1.293-6.421), patients treated with myeloablative conditioning regimen ( HR = 2.463, 95% CI = 1.757-4.320), and patients with acute GVHD (HR = 3.553, 95% CI = 1.809-6.978), sepsis (HR = 3.215, 95% CI = 1.189-6.333 ), or hepatic veno-occlusive disease (VOD) (HR = 3.487, 95% CI = 1.392-6.524). Whereas, HLA histocompatibility showed no striking increased risk for acute renal injury (HR = 1.684, 95% CI = 0.648-4.378). The survival rate was lower in patients with severe nephrotoxicity (21.4%) than in patients without nephrotoxicity (70.6%) (P = 0.001). Conclusions: Nephrotoxicity is the primary risk factor for AKI, severely imp