Journal Article

AKI treated with kidney replacement therapy in critically Ill allogeneic hematopoietic stem cell transplant recipients

Newcomb, Richard, Ali, Rafia, Short, Samuel, Shenoy, Tushar, Leaf, David E., Baron, Rebecca M., Gupta, Shruti, DeFilipp, Zachariah, Kim, Helena, Yilmam, Osman, Monson, Audrey E., Shapiro, Roman M., Soiffer, Robert J., Kaunfer, Sarah, Park, Isabel, Durai, Lavanya, Thomas, Charlotte, Martini, Dylan, Sise, Meghan E., Krishnamurthy, Shobana

2024

Overview

Acute kidney injury (AKI) is a frequent complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), but few studies have focused on AKI treated with kidney replacement therapy (AKI-KRT), particularly among critically ill patients. We investigated the incidence, risk factors, and 90-day mortality associated with AKI-KRT in 529 critically ill adult allo-HSCT recipients admitted to the ICU within 1-year post-transplant at two academic medical centers between 2011 and 2021. AKI-KRT occurred in 111 of the 529 patients (21.0%). Lower baseline eGFR, veno-occlusive disease, thrombotic microangiopathy, admission to an ICU within 90 days post-transplant, and receipt of invasive mechanical ventilation (IMV), total bilirubin ≥5.0 mg/dl, and arterial pH <7.40 on ICU admission were each associated with a higher risk of AKI-KRT. Of the 111 patients with AKI-KRT, 97 (87.4%) died within 90 days. Ninety-day mortality was 100% in each of the following subgroups: serum albumin ≤2.0 g/dl, total bilirubin ≥7.0 mg/dl, arterial pH ≤7.20, IMV with moderate-to-severe hypoxemia, and ≥3 vasopressors/inotropes at KRT initiation. AKI-KRT was associated with a 6.59-fold higher adjusted 90-day mortality in critically ill allo-HSCT vs. non-transplanted patients. Short-term mortality remains exceptionally high among critically ill allo-HSCT patients with AKI-KRT, highlighting the importance of multidisciplinary discussions prior to KRT initiation.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/250/1904 / 631/532/1542 / 692/308/174 / 692/499 / Acute Kidney Injury - etiology / Acute Kidney Injury - therapy / Adult / Allografts / Bilirubin / Cell Biology / Critical Illness - therapy / Health care facilities / Hematology / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic stem cells / Humans / Hypoxemia / Internal Medicine / Kidney transplantation / Kidneys / Mechanical ventilation / Medicine / Medicine & Public Health / Mortality / Public Health / Renal replacement therapy / Renal Replacement Therapy - adverse effects / Retrospective Studies / Risk factors / Serum albumin / Stem cell transplantation / Stem Cells / Subgroups / Thrombotic microangiopathy / Transplants & implants / Veno-occlusive disease