Acute Kidney Injury in Pediatric Patients Receiving Allogeneic Hematopoietic Cell Transplantation: Incidence, Risk Factors, and Outcomes

Acute Kidney Injury in Pediatric Patients Receiving Allogeneic Hematopoietic Cell Transplantation: Incidence, Risk Factors, and Outcomes
Acute kidney injury (AKI) is a common adverse event after hematopoietic cell transplantation (HCT). Although several small studies have evaluated AKI after pediatric HCT, large-scale studies are lacking. In addition, most earlier studies did not use standardized criteria of AKI.
This is a retrospective study, applied on a large pediatric population to establish the incidence and outcomes of AKI and to determine the risk factors associated with AKI after allogeneic HCT.
The study retrospectively analyzed data from 1057 pediatric and adolescent patients who received HCT from January 1991 to December 2015. Modified AKI network (AKIN) classification was used.
The 100-day cumulative incidences of all stages of AKI, stage 3 AKI, and AKI requiring renal replacement therapy (RRT) were 68.2%, 25.0%, and 7.6%, respectively. Overall survival at 1 year was not different between patients without AKI and those with stage 1 or 2 AKI but was significantly different between patients without AKI and patients with stage 3 AKI with or without RRT requirement (66.1% versus 47.3% versus 7.5%, respectively; P.001). Age, year of transplantation, donor type, SOS, and acute GVHD were independent risk factors for stages 1 through 3 AKI. Age, donor, conditioning regimen, number of HCTs, SOS, and acute GVHD were independent risk factors for AKI requiring RRT.
This study does provide a large-scale and comprehensive analysis of AKI from HCT yet with some limiting factors.
First, relying on serum creatinine as a sole measure of AKI with no data on urine output or state of hydration carries potential flaws in the applicability of the modified AKIN criteria. As in these categories of patients receiving HCT for prolonged, complex illnesses, serum creatinine may remain low despite a marked reduction in glomerular filtration rate. Serum creatinine is influenced by multiple factors including diet and muscle mass.
Second, patient enrolment age up to 27 years including young adults might hamper conclusions for pediatric patients.
Third, including patients who received multiple transplants, yet their study enrolment renal condition was not elucidated.
AKI was a prevalent adverse event affecting more than two-thirds of pediatric recipients receiving allogeneic HCTs. Notably, 25% of patients experienced severe stage 3 AKI according to the AKIN criteria, which greatly affected survival outcomes.

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