Acute renal failure following bone marrow transplantation: a retrospective study of 272 patients.
To assess the incidence, risk factors, and course of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 272 patients receiving transplants at the Fred Hutchinson Cancer Research Center during 1986 was undertaken. The patients were divided into three groups: group 1, hemodialysis requiring ARF; group 2, mild renal insufficiency (doubling of serum creatinine, Scr, but no dialysis); group 3, relatively normal post-BMT renal function (no doubling of Scr). Fifty-three percent of patients at least doubled their Scr (Groups 1 and 2), and 24% required dialysis. The degree of renal functional impairment had a dramatic impact on patient mortality rates (84%, 37%, and 17% in groups 1, 2, and 3, respectively). Jaundice (bilirubin greater than or equal to 2.0 mg/dL), weight gain (greater than or equal to 2.0 kg), amphotericin B use, and a pretransplant Scr greater than or equal to 0.7 mg/dL were independently associated with the subsequent development of dialysis-requiring ARF (P less than 0.001; relative risks, 3.0 to 7.7). Neither aminoglycoside/vancomycin/cyclosporine A use nor acute graft v host disease correlated with the development of ARF. A mismatched graft was a significant risk factor for ARF by univariate but not by multivariate analysis. Within 48 hours before doubling the Scr, 63% of group 1 patients had positive blood cultures and 39% developed hypotension. Of the 26 group 1 patients who had urine Na concentrations measured, 85% had values less than or equal to 40 mEq/L. Autopsy kidney specimens provided no clear explanation for ARF in the vast majority of patients in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)
Zager
R A
RA
Department of Medicine, University of Washington, Seattle.
O'Quigley
J
J
Zager
B K
BK
Alpers
C E
CE
Shulman
H M
HM
Gamelin
L M
LM
Stewart
P
P
Thomas
E D
ED
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000666:Amphotericin B / Q000627:therapeutic use; D001835:Body Weight; D016026:Bone Marrow Transplantation; D003404:Creatinine / Q000097:blood; D006650:Histocompatibility Testing; D006801:Humans; D007565:Jaundice / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications
D000666:Amphotericin B; D003404:Creatinine