title: Acute kidney injury in patients with newly diagnosed high-grade hematological malignancies: impact on remission and survival.
abstract: BACKGROUND
  Optimal chemotherapy with minimal toxicity is the main determinant of complete remission in patients with newly diagnosed hematological malignancies. Acute organ dysfunctions may impair the patient's ability to receive optimal chemotherapy.
  
  
  METHODS
  To compare 6-month complete remission rates in patients with and without acute kidney injury (AKI), we collected prospective data on 200 patients with newly diagnosed high-grade malignancies (non-Hodgkin lymphoma, 53.5%; acute myeloid leukemia, 29%; acute lymphoblastic leukemia, 11.5%; and Hodgkin disease, 6%).
  
  
  RESULTS
  According to RIFLE criteria, 137 (68.5%) patients had AKI. Five causes of AKI accounted for 91.4% of cases: hypoperfusion, tumor lysis syndrome, tubular necrosis, nephrotoxic agents, and hemophagocytic lymphohistiocytosis. Half of the AKI patients received renal replacement therapy and 14.6% received suboptimal chemotherapy. AKI was associated with a lower 6-month complete remission rate (39.4% vs. 68.3%, P<0.01) and a higher mortality rate (47.4% vs. 30.2%, P<0.01) than patients without AKI. By multivariate analysis, independent determinants of 6-month complete remission were older age, poor performance status, number of organ dysfunctions, and AKI.
  
  
  CONCLUSIONS
  AKI is common in patients with newly diagnosed high-grade malignancies and is associated with lower complete remission rates and higher mortality.
authors: Medical Intensive Care Unit, Saint-Louis University Hospital, Paris, France. emmanuel.canet@sls.aphp.fr
authors: Emmanuel
authors: E
authors: Canet
authors: Lara
authors: L
authors: Zafrani
authors: Jerome
authors: J
authors: Lambert
authors: Catherine
authors: C
authors: Thieblemont
authors: Lionel
authors: L
authors: Galicier
authors: David
authors: D
authors: Schnell
authors: Emmanuel
authors: E
authors: Raffoux
authors: Etienne
authors: E
authors: Lengline
authors: Sylvie
authors: S
authors: Chevret
authors: Michael
authors: M
authors: Darmon
authors: Elie
authors: E
authors: Azoulay
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012074:Remission Induction; D017582:Renal Replacement Therapy; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents