The impact of kidney function on survival in elderly patients diagnosed with acute myeloid leukemia

Acute myeloid leukemia (AML) is an aggressive hematological cancer that involves myeloid cells. Elderly patients with comorbidities and poor performance status (PS) receive treatment with hypomethylating agents or supportive care. Several models are available to predict treatment-related mortality and they all primarily focus on PS. Little is known about the impact of chronic kidney disease (CKD) on survival in elderly patients with AML.

We performed a retrospective analysis of 81 patients (51.9% male) aged over 65 years when the diagnosis of AML was established. The median observation period lasted 108 days (IQR 292, maximum 1,169). Patients' documentation was examined for previous illnesses, PS was calculated, basic laboratory blood tests and a bone marrow biopsy were done. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m².

The median age of patients was 75 years (IQR 14, maximum 93). The mean eGFR was 59.5 ± 24.0 mL/min/1.73m². CKD was present in almost half of patients (49.4%). Altogether, 69 (85.2%) patients died during the observation period. Kaplan-Meier survival analysis showed statistically lower survival for CKD patients (log-rank χ2 = 6.736; p = 0.009). Cox regression model, adjusted for age, comorbidities, and treatment, revealed the main predictors for patient survival to be PS, AML type, and blast percentage.

Our results indicate that elderly patients with AML have worse survival when diagnosed with CKD, however CKD was not one of the main predictors of patient survival.