Acute renal failure in patients following bone marrow transplantation: prevalence, risk factors and outcome.
To assess the prevalence, risk factors, clinical causes and outcome of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 275 patients was undertaken. ARF was diagnosed in 72 patients (26%) and occurred in 81.9% within the first month. The three main clinical causes were multifactorial (36%), nephrotoxic (29%), and veno-occlusive disease of the liver (VOD) 15%. The prevalence was higher in allogeneic BMT (36%) than in autologous BMT (6.5%). Risk factors related to the development of ARF wee preexisting VOD and age older than 25 years. Logistic regression in allogeneic BMT confirmed this association (VOD, odds ratio 3.8; age offer than 25, odds ratio 1.9). Underlying disease, graft-versus-host disease, sepsis, conditioning therapy, and sex were not associated with ARF. Seventeen cases of ARF required hemodialysis (24%) mainly in association with VOD (70.5%). The overall morality from ARF was 45.8%, the dialyzed group having the highest mortality (88%). Survival in the ARF group was continuously worse up to 3 months and the actuarial survival at 10 years was 29.7 versus 53.2%. We conclude that ARF is a common complication mainly in allogeneic BMT and carries a grave prognosis. VOD and age were risk factors for ARF.
Department of Nephrology, Princesa Hospital, Autónoma University, Madrid, Spain.
E
E
Gruss
C
C
Bernis
J F
JF
Tomas
C
C
Garcia-Canton
A
A
Figuera
J L
JL
Motellón
V
V
Paraiso
J A
JA
Traver
J M
JM
Fernandez-Rañada
D000206:Actuarial Analysis; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000367:Age Factors; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000150:complications; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous