Risk factors for severe acute kidney injury after pediatric hematopoietic cell transplantation

Abbie Bauer, Kristen Carlin, Stephen M. Schwartz, Meera Srikanthan, Monica Thakar, Lauri M. Burroughs, Jodi Smith, Sangeeta Hingorani, Shina Menon

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Acute kidney injury (AKI) is common after hematopoietic cell transplantation (HCT) and is associated with poorer outcomes. Risk factors for AKI after pediatric HCT are not fully understood. The study objective was to assess unique risk factors for AKI in the HCT population and evaluate post-HCT AKI patterns. Methods: We conducted a retrospective cohort study of patients < 21 years of age who underwent HCT at Seattle Children’s Hospital/Fred Hutchinson Cancer Center from September 2008 to July 2017 (n = 484). We defined AKI using KDIGO criteria. We collected demographics, baseline HCT characteristics, post-HCT complications, and mortality. Multinomial logistic regression was used to estimate association between AKI and potential risk factors. We used adjusted Cox proportional hazard ratios to evaluate differences in mortality. Results: One hundred and eighty-six patients (38%) developed AKI. Seventy-nine (42%) had severe AKI and 27 (15%) required kidney replacement therapy. Fluid overload was common in all groups and 67% of those with severe AKI had > 10% fluid overload. Nephrology was consulted in less than 50% of those with severe AKI. In multivariable analysis, risk of severe AKI was lower in those taking a calcineurin inhibitor (CNI). Risk of death was higher in severe AKI compared to no AKI (RR 4.6, 95% CI 2.6–8.1). Conclusions: AKI and fluid overload are common in pediatric patients after HCT. Severe AKI occurred less often with CNI use and was associated with higher mortality. Future interventions to reduce AKI and its associated complications such as fluid overload are approaches to reducing morbidity and mortality after HCT. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish (US)
JournalPediatric Nephrology
DOIs
StateAccepted/In press - 2022

Keywords

  • Acute kidney injury
  • Calcineurin inhibitors
  • Fluid overload
  • Hematopoietic cell transplantation
  • Pediatrics
  • Risk factors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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