title: Acute renal failure following allogeneic hematopoietic cell transplantation: incidence, outcome and risk factors.
abstract: Renal insufficiency is a common complication early after hematopoietic cell transplantation (HCT). We retrospectively examined the incidence, risk factors and associated mortality of acute renal failure (ARF) in a cohort of 101 consecutive allogeneic HCT patients. These patients were reviewed to determine their baseline characteristics, the presence of co-morbid conditions and mortality rates at one year. ARF was defined by the doubling of the baseline serum creatinine (Scr) levels. The mean age of the 101 study patients was 34 ± 11.8 years. Of them, 58 (57.4%) had ARF, yielding an incidence of 2.6% per week during the first year following HCT. The peak frequency of ARF occurred during the second week (29.3%). The need for hemodialysis, a proof of the severity of ARF, was seen in 12 cases (20.7%). On univariate analysis, the Scr at one month greater than 90 μmol/L (P = 0.008), use of aminoglycosides (P < 10 -3 ), the presence of veno-occlusive disease (VOD) (P < 10 -3 ) and the need for admission to the intensive care unit (ICU) (P = 0.003) were associated with a significantly increased risk of ARF. On multivariate analysis, the independent variables associated with an increased risk for ARF were the presence of VOD [P = 0.07, relative risk (RR) = 2.06] and use of aminoglycosides (P < 10 -3 , RR = 11.2). The overall mortality rate among the study patients was 35.6% at the end of the first year. On multivariate analysis, only the use of aminoglycosides (P = 0.02, RR = 0.31), admission to the ICU (P < 10 -3, RR = 7.29) and the development of ARF (P = 0.001, RR = 8.97) were independent predictors of mortality. Our study shows that ARF is highly prevalent during the early period following HCT and increases mortality, particularly if dialysis dependent. It frequently occurs following VOD and aminoglycoside use. As the prognosis is rather grim, it is very important that the associated factors be identified early, for an effective prevention of this disease.
authors.affiliation: Department of Renal Transplantation, Necker Hospital, Paris, France. imedhela1@voila.fr
authors.forename: Imed
authors.initials: I
authors.lastname: Helal
authors.forename: Anies
authors.initials: A
authors.lastname: Byzun
authors.forename: Jean Philipe
authors.initials: JP
authors.lastname: Rerolle
authors.forename: Emanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Henri
authors.initials: H
authors.lastname: Kreis
authors.forename: Marie France
authors.initials: MF
authors.lastname: Bruneel-Mamzer
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000617:Aminoglycosides / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014652:Vascular Diseases / Q000150:complications; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D003404:Creatinine