Tags

Type your tag names separated by a space and hit enter

Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors.
Kidney Int. 2005 Jan; 67(1):272-7.KI

Abstract

BACKGROUND

Survival after myeloablative therapy followed by hematopoietic cell transplant (HCT) is limited by substantial treatment-related toxicities. Acute renal failure (ARF) develops in 25% to 50% of patients after HCT.

METHODS

One hundred forty-seven patients were followed prospectively from time of transplant. ARF was defined as a doubling of baseline serum creatinine at any time during the first 100 days post-transplant. We conducted a nested case-control study to identify precipitants of ARF. For each person who developed ARF, 2 controls were selected at random from patients who had not developed ARF as of that time. An exposure period was defined for each case as the 2 weeks prior to the day on which the matched case met the criteria for ARF. The risk of ARF in relation to demographic and anthropometric characteristics, and to types of treatment and comorbidity, was examined using univariable and multivariable conditional logistic regression models. Odds ratios for the associations with ARF were estimated, taking into account the matching.

RESULTS

Fifty-three patients (36%) developed ARF at a median of 33 days after transplant (range 1 to 97). Elevated risks were observed in patients who received liposomal amphotericin (OR 6.58; 95%CI 1.45-29.95) and conventional (OR 3.60; 95%CI 0.79-16.55), and in those patients with sinusoidal obstruction syndrome (SOS) (previously termed veno-occlusive disease) (OR 9.37; 95%CI 2.29-38.38). For every 0.1 mg/dL increase in baseline serum Cr, the risk of ARF decreased by 30%. Neither total body irradiation (TBI) dose, levels of metabolites of cyclophosphamide, sepsis, acute graft versus host disease (GVHD), nor cyclosporine (CSA) levels was associated with an increased risk of ARF.

CONCLUSION

The cumulative incidence of ARF after HCT remains high. Amphotericin use during the 2-week exposure period and presence of hepatic sinuosoidal injury increased the risk of ARF within the first 100 days after HCT. Higher levels of serum creatinine at baseline were associated with a lower risk of ARF.

Authors+Show Affiliations

Department of Pediatrics and Medicine, University of Washington, Seattle, Washington, USA. sangeeta.hingorani@seattlechildrens.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15610251

Citation

Hingorani, Sangeeta R., et al. "Acute Renal Failure After Myeloablative Hematopoietic Cell Transplant: Incidence and Risk Factors." Kidney International, vol. 67, no. 1, 2005, pp. 272-7.
Hingorani SR, Guthrie K, Batchelder A, et al. Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors. Kidney Int. 2005;67(1):272-7.
Hingorani, S. R., Guthrie, K., Batchelder, A., Schoch, G., Aboulhosn, N., Manchion, J., & McDonald, G. B. (2005). Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors. Kidney International, 67(1), 272-7.
Hingorani SR, et al. Acute Renal Failure After Myeloablative Hematopoietic Cell Transplant: Incidence and Risk Factors. Kidney Int. 2005;67(1):272-7. PubMed PMID: 15610251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors. AU - Hingorani,Sangeeta R, AU - Guthrie,Katherine, AU - Batchelder,Ami, AU - Schoch,Gary, AU - Aboulhosn,Nada, AU - Manchion,Janel, AU - McDonald,George B, PY - 2004/12/22/pubmed PY - 2005/6/23/medline PY - 2004/12/22/entrez SP - 272 EP - 7 JF - Kidney international JO - Kidney Int VL - 67 IS - 1 N2 - BACKGROUND: Survival after myeloablative therapy followed by hematopoietic cell transplant (HCT) is limited by substantial treatment-related toxicities. Acute renal failure (ARF) develops in 25% to 50% of patients after HCT. METHODS: One hundred forty-seven patients were followed prospectively from time of transplant. ARF was defined as a doubling of baseline serum creatinine at any time during the first 100 days post-transplant. We conducted a nested case-control study to identify precipitants of ARF. For each person who developed ARF, 2 controls were selected at random from patients who had not developed ARF as of that time. An exposure period was defined for each case as the 2 weeks prior to the day on which the matched case met the criteria for ARF. The risk of ARF in relation to demographic and anthropometric characteristics, and to types of treatment and comorbidity, was examined using univariable and multivariable conditional logistic regression models. Odds ratios for the associations with ARF were estimated, taking into account the matching. RESULTS: Fifty-three patients (36%) developed ARF at a median of 33 days after transplant (range 1 to 97). Elevated risks were observed in patients who received liposomal amphotericin (OR 6.58; 95%CI 1.45-29.95) and conventional (OR 3.60; 95%CI 0.79-16.55), and in those patients with sinusoidal obstruction syndrome (SOS) (previously termed veno-occlusive disease) (OR 9.37; 95%CI 2.29-38.38). For every 0.1 mg/dL increase in baseline serum Cr, the risk of ARF decreased by 30%. Neither total body irradiation (TBI) dose, levels of metabolites of cyclophosphamide, sepsis, acute graft versus host disease (GVHD), nor cyclosporine (CSA) levels was associated with an increased risk of ARF. CONCLUSION: The cumulative incidence of ARF after HCT remains high. Amphotericin use during the 2-week exposure period and presence of hepatic sinuosoidal injury increased the risk of ARF within the first 100 days after HCT. Higher levels of serum creatinine at baseline were associated with a lower risk of ARF. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/15610251/Acute_renal_failure_after_myeloablative_hematopoietic_cell_transplant:_incidence_and_risk_factors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)50450-X DB - PRIME DP - Unbound Medicine ER -