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Acute kidney injury and risk factors in pediatric patients undergoing hematopoietic stem cell transplantation
Begüm Avcı1,2, Özlem Arman Bilir3, Sare Gülfem Özlü4
1Department of Pediatric Nephrology, Baskent University, Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey. begumavcidr@gmail.com.
Insights
Acute kidney injury (AKI) is a significant risk for children undergoing hematopoietic stem cell transplantation (HSCT). Older age, certain complications, and nephrotoxic drugs are key risk factors requiring close monitoring and early intervention.
Area of Science:
- Pediatric Hematology
- Nephrology
- Transplantation Medicine
Background:
- Acute kidney injury (AKI) is a frequent and serious complication following hematopoietic stem cell transplantation (HSCT).
- AKI in pediatric HSCT patients is associated with increased mortality and morbidity.
- Identifying risk factors for AKI is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of AKI in pediatric patients post-HSCT.
- To identify independent risk factors associated with AKI development.
- To evaluate the prognosis, including mortality and long-term kidney function, in pediatric HSCT patients with AKI.
Main Methods:
- A retrospective case-control study was conducted involving 278 pediatric patients who underwent HSCT.
- Patients were categorized into AKI and non-AKI groups for comparative analysis.
- Logistic regression analysis was utilized to identify significant risk factors for AKI.
Main Results:
- The incidence of AKI was 16.9%, with 8.5% requiring kidney replacement therapy.
- Independent risk factors for AKI included older age, sinusoidal obstruction syndrome, hemorrhagic cystitis, and exposure to nephrotoxic drugs (e.g., calcineurin inhibitors, amikacin, vancomycin).
- Higher mortality rates and AKI-related mortality were observed in patients with stage 3 AKI compared to stages 1 and 2.
Conclusions:
- AKI presents a substantial threat to pediatric patients post-HSCT, contributing to significant mortality and morbidity.
- Early identification of AKI risk factors and proactive preventive strategies are essential for mitigating adverse outcomes.
- Close monitoring of pediatric HSCT patients is vital for timely intervention and improved survival rates.
Background:
Acute kidney injury (AKI) is a common complication of hematopoietic stem cell transplantation (HSCT) with increased mortality and morbidity. Understanding the risk factors for AKI is essential. This study aimed to identify AKI incidence, risk factors, and prognosis in pediatric patients post-HSCT.
Methods:
We conducted a retrospective case-control study of 278 patients who were divided into two groups: those with AKI and those without AKI (non-AKI). The groups were compared based on the characteristics and clinical symptoms of patients, as well as post-HSCT complications and the use of nephrotoxic drugs. Logistic regression analysis was employed to identify the risk factors for AKI.
Results:
A total of 16.9% of patients had AKI, with 8.5% requiring kidney replacement therapy. Older age (OR 1.129, 95% CI 1.061-1.200, p < 0.001), sinusoidal obstruction syndrome (OR 2.562, 95% CI 1.216-5.398, p = 0.011), hemorrhagic cystitis (OR 2.703, 95% CI 1.178-6.199, p = 0.016), and nephrotoxic drugs, including calcineurin inhibitors, amikacin, and vancomycin (OR 17.250, 95% CI 2.329-127.742, p < 0.001), were identified as significant independent risk factors for AKI following HSCT. Mortality rate and mortality due to AKI were higher in stage 3 patients than those in stage 1 and 2 AKI (p = 0.019, p = 0.007, respectively). Chronic kidney disease developed in 1 patient (0.4%), who was in stage 1 AKI (2.1%).
Conclusions:
AKI poses a serious threat to children post-HSCT, leading to alarming rates of mortality and morbidity. To enhance outcomes and mitigate these risks, it is vital to identify AKI risk factors, adopt early preventive strategies, and closely monitor this patient group.
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