Mima Akira, Tansho Kousuke, Nagahara Dai, Tsubaki Kazuo
Department of Nephrology, Kindai University Faculty of Medicine, Kindai University Nara Hospital, Nara, Japan.
Department of Hematology, Kindai University Faculty of Medicine, Kindai University Nara Hospital, Nara, Japan.
PeerJ. 2019 Feb 28;7:e6467. doi: 10.7717/peerj.6467. eCollection 2019.
Previous reports have shown that acute kidney injury (AKI) is common after hematopoietic stem cell transplantation (HSCT), which is a crucial treatment for patients with hematological disorders. AKI could increase mortality and induce adverse effects including the development of chronic kidney disease. The incidence of AKI in association with HSCT reportedly varies significantly because several definitions of AKI have been adopted. Acute kidney disease (AKD) is a new concept that can clinically define both AKI and persistent decreases in glomerular filtration rate (GFR) state. We conducted a retrospective cohort study to determine the incidence of AKD after HSCT.
This study included 108 patients aged between 16 and 70 years undergoing HSCT. In this study, AKD included clinical condition of AKI or subacute decreases in GFR. AKI was defined according to the Kidney Disease: Improving Global Outcomes guidelines based on serum creatinine. However, urine output data were not included to define AKI because the database lacked some of these data. Comparisons were made between groups using the Mann-Whitney U test.
Acute kidney disease occurred in 17 patients (15.7%). There were significant differences between the AKD and non-AKD with respect to ABO-incompatible HSCT ( = 0.001) and incidence of acute graft versus host disease (GVHD) after HSCT ( < 0.001). The 100-day overall survival of patients with AKD and without AKD after HSCT was 70.6% and 79.8%, respectively ( = 0.409).
ABO-incompatible HSCT and acute GVHD after HSCT were risk factors for the incidence of AKD. However, we could not find a significant association between AKD after HSCT and mortality.
既往报告显示，急性肾损伤（AKI）在造血干细胞移植（HSCT）后很常见，HSCT是血液系统疾病患者的关键治疗方法。AKI可增加死亡率并引发包括慢性肾脏病发展在内的不良反应。据报道，与HSCT相关的AKI发病率差异显著，因为采用了几种AKI的定义。急性肾脏病（AKD）是一个新的概念，它可以在临床上定义AKI以及肾小球滤过率（GFR）持续下降的状态。我们进行了一项回顾性队列研究，以确定HSCT后AKD的发病率。
本研究纳入了108例年龄在16至70岁之间接受HSCT的患者。在本研究中，AKD包括AKI的临床情况或GFR的亚急性下降。AKI根据基于血清肌酐的《改善全球肾脏病预后组织（KDIGO）指南》进行定义。然而，由于数据库缺少部分尿量数据，因此在定义AKI时未纳入尿量数据。使用Mann-Whitney U检验在组间进行比较。
17例患者（15.7%）发生了急性肾脏病。在ABO血型不相合的HSCT方面（P = 0.001）以及HSCT后急性移植物抗宿主病（GVHD）的发生率方面（P < 0.001），AKD组与非AKD组之间存在显著差异。HSCT后发生AKD和未发生AKD的患者100天总生存率分别为70.6%和79.8%（P = 0.409）。
ABO血型不相合的HSCT以及HSCT后急性GVHD是AKD发病率的危险因素。然而，我们未发现HSCT后AKD与死亡率之间存在显著关联。
