Risk factors for severe acute kidney injury after pediatric hematopoietic cell transplantation View Full Text


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Article Info

DATE

2022-09-20

AUTHORS

Abbie Bauer, Kristen Carlin, Stephen M. Schwartz, Meera Srikanthan, Monica Thakar, Lauri M. Burroughs, Jodi Smith, Sangeeta Hingorani, Shina Menon

ABSTRACT

BackgroundAcute kidney injury (AKI) is common after hematopoietic cell transplantation (HCT) and is associated with poorer outcomes. Risk factors for AKI after pediatric HCT are not fully understood. The study objective was to assess unique risk factors for AKI in the HCT population and evaluate post-HCT AKI patterns.MethodsWe conducted a retrospective cohort study of patients < 21 years of age who underwent HCT at Seattle Children’s Hospital/Fred Hutchinson Cancer Center from September 2008 to July 2017 (n = 484). We defined AKI using KDIGO criteria. We collected demographics, baseline HCT characteristics, post-HCT complications, and mortality. Multinomial logistic regression was used to estimate association between AKI and potential risk factors. We used adjusted Cox proportional hazard ratios to evaluate differences in mortality.ResultsOne hundred and eighty-six patients (38%) developed AKI. Seventy-nine (42%) had severe AKI and 27 (15%) required kidney replacement therapy. Fluid overload was common in all groups and 67% of those with severe AKI had > 10% fluid overload. Nephrology was consulted in less than 50% of those with severe AKI. In multivariable analysis, risk of severe AKI was lower in those taking a calcineurin inhibitor (CNI). Risk of death was higher in severe AKI compared to no AKI (RR 4.6, 95% CI 2.6–8.1).ConclusionsAKI and fluid overload are common in pediatric patients after HCT. Severe AKI occurred less often with CNI use and was associated with higher mortality. Future interventions to reduce AKI and its associated complications such as fluid overload are approaches to reducing morbidity and mortality after HCT.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information More... »

PAGES

1-8

References to SciGraph publications

  • 2017-03-03. Follow-up of Acute kidney injury in Neonates during Childhood Years (FANCY): a prospective cohort study in PEDIATRIC NEPHROLOGY
  • 2010-08-09. Early clinical indicators of transplant-associated thrombotic microangiopathy in pediatric neuroblastoma patients undergoing auto-SCT in BONE MARROW TRANSPLANTATION
  • 2020-08-27. Independent risk factors and long-term outcomes for acute kidney injury in pediatric patients undergoing hematopoietic stem cell transplantation: a retrospective cohort study in BMC NEPHROLOGY
  • 2016-10-12. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis in INTENSIVE CARE MEDICINE
  • 2022-05-20. Predictors of kidney complications and analysis of hypertension in children with allogeneic hematopoietic stem cell transplantation in PEDIATRIC NEPHROLOGY
  • 2019-08-27. Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors in BONE MARROW TRANSPLANTATION
  • 2016-11-30. The role of fluid overload in the prediction of outcome in acute kidney injury in PEDIATRIC NEPHROLOGY
  • 2018-06-26. Implementation of preemptive fluid strategy as a bundle to prevent fluid overload in children with acute respiratory distress syndrome and sepsis in BMC PEDIATRICS
  • 2016-08-02. Fluid overload in the ICU: evaluation and management in BMC NEPHROLOGY
  • 2022-02-28. Acute kidney injury in pediatric hematopoietic cell transplantation: critical appraisal and consensus in PEDIATRIC NEPHROLOGY
  • 2003-11-22. Fluid overload and acute renal failure in pediatric stem cell transplant patients in PEDIATRIC NEPHROLOGY
  • 2021-01-07. Outcomes of kidney injury including dialysis and kidney transplantation in pediatric oncology and hematopoietic cell transplant patients in PEDIATRIC NEPHROLOGY
  • 2017-06-14. Accuracy of neutrophil gelatinase-associated lipocalin for acute kidney injury diagnosis in children: systematic review and meta-analysis in PEDIATRIC NEPHROLOGY
  • 2019-01-30. A novel strategy for identifying early acute kidney injury in pediatric hematopoietic stem cell transplantation in BONE MARROW TRANSPLANTATION
  • 2017-02-20. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria in BMC NEPHROLOGY
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    http://scigraph.springernature.com/pub.10.1007/s00467-022-05731-x

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    28 BackgroundAcute kidney injury
    29 CNI use
    30 Cancer Center
    31 ConclusionsAKI
    32 Cox proportional hazard ratios
    33 Fred Hutchinson Cancer Center
    34 Graphical Abstract
    35 Graphical abstractA higher resolution version
    36 HCT population
    37 KDIGO criteria
    38 MethodsWe
    39 Pediatric Hematopoietic Cell Transplantation
    40 ResultsOne hundred
    41 acute kidney injury
    42 age
    43 analysis
    44 approach
    45 association
    46 calcineurin inhibitors
    47 cell transplantation
    48 center
    49 characteristics
    50 cohort study
    51 complications
    52 criteria
    53 death
    54 demographics
    55 differences
    56 factors
    57 fluid overload
    58 future interventions
    59 group
    60 hazard ratio
    61 hematopoietic cell transplantation
    62 high mortality
    63 high-resolution version
    64 hundreds
    65 information risk factor
    66 inhibitors
    67 injury
    68 intervention
    69 kidney injury
    70 kidney replacement therapy
    71 logistic regression
    72 morbidity
    73 mortality
    74 multinomial logistic regression
    75 multivariable analysis
    76 nephrology
    77 objective
    78 outcomes
    79 overload
    80 patients
    81 patterns
    82 pediatric patients
    83 poor outcome
    84 population
    85 post-HCT complications
    86 potential risk factors
    87 proportional hazard ratios
    88 ratio
    89 regression
    90 replacement therapy
    91 resolution version
    92 retrospective cohort study
    93 risk
    94 risk factors
    95 risk of death
    96 severe AKI
    97 severe acute kidney injury
    98 study
    99 study objective
    100 therapy
    101 transplantation
    102 unique risk factors
    103 use
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    105 years
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