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根据肌酐清除率定义的轻度肾功能不全对异基因造血干细胞移植后的临床结局影响有限。

Mild renal dysfunction defined by creatinine clearance rate has limited impact on clinical outcomes after allogeneic hematopoietic stem cell transplantation.

作者信息

Ikegawa Shuntaro, Matsuoka Ken-Ichi, Inomata Tomoko, Ikeda Naoto, Sugiura Hiroyuki, Kuroi Taiga, Asano Takeru, Yoshida Shohei, Nishimori Hisakazu, Fujii Nobuharu, Kondo Eisei, Maeda Yoshinobu, Tanimoto Mitsune

机构信息

Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kita-ku, Okayama, Okayama, 700-0914, Japan.

出版信息

Int J Hematol. 2018 May;107(5):568-577. doi: 10.1007/s12185-017-2398-7. Epub 2018 Jan 4.

Abstract

Creatinine clearance rate (Ccr) is a more accurate indicator of renal function than serum creatinine. Data are sparse regarding the prognostic value of renal impairment calculated using Ccr in patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT). We performed a retrospective analysis of 185 patients who underwent allo-HSCT. These patients were divided into two groups by Ccr (ml/min) before transplantation; one showed normal renal function (Ccr ≥ 60, n = 156) and the other showed mild renal dysfunction (30 ≤ Ccr < 60, n = 29), and transplant outcomes were compared between the groups. We observed no significant difference between the groups in terms of clinical characteristics other than age, estimated glomerular filtration rate, serum creatinine, Ccr predicted by Cockcroft-Gault formula, primary disease, and conditioning intensity. With respect to transplant outcomes, no significant difference was observed in overall survival, relapse, or non-relapse mortality between the two groups. Multivariate analysis demonstrated that 30 ≤ Ccr < 60 before allo-HSCT was not an independent prognostic factor for transplant outcome. In conclusion, these results suggest that patients with mild renal dysfunction, defined as 30 ≤ Ccr < 60 ml/min, can safely undergo allo-HSCT. However, a larger series of patients is needed to evaluate the impact of mild renal dysfunction before allo-HSCT in more detail.

摘要

肌酐清除率(Ccr)是比血清肌酐更准确的肾功能指标。关于在接受异基因造血干细胞移植(allo-HSCT)的患者中使用Ccr计算的肾功能损害的预后价值的数据很少。我们对185例接受allo-HSCT的患者进行了回顾性分析。这些患者在移植前根据Ccr(毫升/分钟)分为两组;一组显示肾功能正常(Ccr≥60,n = 156),另一组显示轻度肾功能不全(30≤Ccr<60,n = 29),并比较了两组之间的移植结果。除年龄、估计肾小球滤过率、血清肌酐、Cockcroft-Gault公式预测的Ccr、原发性疾病和预处理强度外,我们观察到两组在临床特征方面无显著差异。关于移植结果,两组之间在总生存期、复发率或非复发死亡率方面未观察到显著差异。多变量分析表明,allo-HSCT前30≤Ccr<60不是移植结果的独立预后因素。总之,这些结果表明,定义为30≤Ccr<60毫升/分钟的轻度肾功能不全患者可以安全地接受allo-HSCT。然而,需要更多的患者系列来更详细地评估allo-HSCT前轻度肾功能不全的影响。

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