title: Acute renal failure requiring dialysis after allogeneic blood and marrow transplantation identifies very poor prognosis patients.
abstract: We examined the incidence, risk factors and associated mortality of acute renal failure requiring dialysis (Renal Bearman Grade [BG] 3) in a 3-year cohort of 97 consecutive allogeneic blood and marrow transplantation (alloBMT) patients. In all, 20 (21%) developed Renal BG3 (all died by day +132) and 77 (79%) developed renal insufficiency (Renal BG1-2). Renal BG3 was a contributing or primary cause of death in 18 (90%) patients who continued to require dialysis at time of death. The two Renal BG3 patients whose deaths were not related to renal failure died on day +103 of hemorrhage and day +132 of underlying disease. By univariate analysis, age, unrelated donor, veno-occlusive disease (VOD) and grade III-IV acute graft-versus-host disease with hepatic involvement were significantly associated with Renal BG3. The multivariate model of time to Renal BG3 determined only a prior diagnosis of severe acute GVHD (RR=4.1, 95% CI 1.6-10.3, P=0.003) and VOD (RR=9.1, 95% CI 3.5-23.7, P<0.001) as significant independent predictors. Renal BG3 is generally considered a conditioning regimen-related toxicity. This study demonstrates that Renal BG3 is most commonly a complication of hepatic co-morbidities after allogeneic blood and marrow transplantation and identifies patients with a very poor prognosis.
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
authors.forename: T
authors.initials: T
authors.lastname: Hahn
authors.forename: C
authors.initials: C
authors.lastname: Rondeau
authors.forename: A
authors.initials: A
authors.lastname: Shaukat
authors.forename: V
authors.initials: V
authors.lastname: Jupudy
authors.forename: A
authors.initials: A
authors.lastname: Miller
authors.forename: A R
authors.initials: AR
authors.lastname: Alam
authors.forename: M R
authors.initials: MR
authors.lastname: Baer
authors.forename: B
authors.initials: B
authors.lastname: Bambach
authors.forename: Z
authors.initials: Z
authors.lastname: Bernstein
authors.forename: A A
authors.initials: AA
authors.lastname: Chanan-Khan
authors.forename: M S
authors.initials: MS
authors.lastname: Czuczman
authors.forename: J
authors.initials: J
authors.lastname: Slack
authors.forename: M
authors.initials: M
authors.lastname: Wetzler
authors.forename: B K
authors.initials: BK
authors.lastname: Mookerjee
authors.forename: J
authors.initials: J
authors.lastname: Silva
authors.forename: P L
authors.initials: PL
authors.lastname: McCarthy
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000379:methods*; D016026:Bone Marrow Transplantation; D002648:Child; D015331:Cohort Studies; D006086:Graft vs Host Disease / Q000517:prevention & control / Q000628:therapy; D006504:Hepatic Veno-Occlusive Disease / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous