title: Acute Kidney Injury and the Risk of Mortality in Children Undergoing Hematopoietic Stem Cell Transplantation.
abstract: Acute kidney injury (AKI) is a well-documented complication of pediatric hematopoietic stem cell transplantation (HSCT). Dialysis after HSCT is associated with a lower overall survival (OS); however, the association between less severe AKI and OS is unclear. We retrospectively studied 205 consecutive pediatric HSCT patients to determine the incidence and impact of all stages of AKI on OS in pediatric HSCT recipients. We used the peak pRIFLE grade during the first 100 days to classify AKI (ie, R = risk, I = injury, F = failure, L = loss of function, E = end-stage renal disease) and used the modified Schwartz formula to estimate glomerular filtration rate. AKI was observed in 173 of 205 patients (84%). The 1-year OS rate decreased significantly with an increasing severity of pRIFLE grades (P < .01). There was no difference in the OS between patients without AKI and the R/I group. Regardless of the dialysis status, stages F/L/E had significantly lower rates of OS compared with patients without AKI or R/I (P < .01). There was no difference in OS among patients with dialysis and F/L/E without dialysis (P = .65). Stages F/L/E predicted mortality independent of acute graft-versus-host disease, gender, and malignancy. The OS of children after HSCT decreases significantly with an increasing severity of AKI within the first 100 days post-transplant. Although our data did not show an increased risk of mortality with stages R/I, stages F/L/E predicted mortality regardless of dialysis. Prevention and minimization of AKI may improve survival after pediatric HSCT.
authors.affiliation: Department of Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota. Electronic address: kizil010@umn.edu.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Kizilbash
authors.affiliation: Department of Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Clifford E
authors.initials: CE
authors.lastname: Kashtan
authors.affiliation: Department of Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Blanche M
authors.initials: BM
authors.lastname: Chavers
authors.affiliation: Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Qing
authors.initials: Q
authors.lastname: Cao
authors.affiliation: Department of Pediatrics, Pediatric Blood and Marrow Transplant Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Smith
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014019:Tissue Donors; D014652:Vascular Diseases; D055815:Young Adult
keywords: Acute kidney injury; Chronic kidney disease; Mortality; Pediatric hematopoietic stem cell transplantation