Department of General Internal Medicine, Ambulatory Treatment and Emergency Center, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Cancer. 2010 Sep 1;116(17):4063-8. doi: 10.1002/cncr.25306.
: Acute kidney injury (AKIis a common complication in the treatment of patients with acute myelogenous leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS), but, to the authors' knowledge, its clinical relevance has not been detailed to date. The objective of the current study was to identify the incidence, predictors, and outcome for AKI in patients with AML and HR-MDS.
: Data were analyzed from 537 patients with AML or HR-MDS undergoing induction chemotherapy from 1999 to 2007. Predictors for AKI were identified by logistic regression. Eight-week mortality of patients was estimated by the Kaplan-Meier method stratified by the RIFLE criteria, a novel multilevel classification system for AKI based on the percent rise in serum creatinine from baseline (Risk, >50%; Injury, >100%; and Failure, >200% or requiring dialysis).
: A total of 187 patients (36%) developed AKI. Significant independent risk factors for AKI included the following: age >/=55 years (odds ratio [OR], 1.8), mechanical ventilation (OR, 16), use of vancomycin (OR, 2.3), diuretics (OR, 3.0), amphotericin B lipid formulation (OR, 2.7), vasopressors (OR, 4.9), leukopenia (OR, 1.9), hypoalbuminemia (OR, 1.4), and use of non-fludarabine-based chemotherapy (OR, 2.7). The 8-week mortality rates were 3.8%, 13.6%, 19.6%, and 61.7% for the non-RIFLE, Risk, Injury, and Failure categories, respectively. Patients requiring dialysis (8%) had a median survival of 33 days. Survival of patients who achieved complete remission was favorable, regardless of degree of AKI.
: The RIFLE classification for AKI appears to have prognostic utility in predicting mortality in patients with AML or HR-MDS. Relatively mild elevations in creatinine are associated with higher mortality. Strategies to avoid nephrotoxic drugs or fluid overload may be of benefit. Cancer 2010. (c) 2010 American Cancer Society.
急性肾损伤（AKI）是急性髓系白血病（AML）或高危骨髓增生异常综合征（HR-MDS）患者治疗中的常见并发症，但据作者所知，其临床相关性尚未详细描述。本研究的目的是确定 AML 和 HR-MDS 患者发生 AKI 的发生率、预测因素和结局。
分析了 1999 年至 2007 年期间接受诱导化疗的 537 例 AML 或 HR-MDS 患者的数据。通过逻辑回归确定 AKI 的预测因素。采用 Kaplan-Meier 法估计患者 8 周死亡率，分层依据是新的基于血清肌酐从基线升高百分比的多水平 AKI 分类系统（风险，>50%；损伤，>100%；衰竭，>200%或需要透析）。
共有 187 例（36%）患者发生 AKI。AKI 的显著独立危险因素包括：年龄≥55 岁（比值比[OR]，1.8）、机械通气（OR，16）、万古霉素（OR，2.3）、利尿剂（OR，3.0）、两性霉素 B 脂质体（OR，2.7）、血管加压素（OR，4.9）、白细胞减少（OR，1.9）、低白蛋白血症（OR，1.4）和使用非氟达拉滨为基础的化疗（OR，2.7）。非 RIFLE、风险、损伤和衰竭组的 8 周死亡率分别为 3.8%、13.6%、19.6%和 61.7%。需要透析的患者（8%）中位生存时间为 33 天。完全缓解的患者生存情况良好，与 AKI 程度无关。
AKI 的 RIFLE 分类似乎具有预测 AML 或 HR-MDS 患者死亡率的预后效用。肌酐的相对轻微升高与更高的死亡率相关。避免使用肾毒性药物或液体超负荷的策略可能有益。癌症 2010。（c）2010 年美国癌症协会。
