Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt, Germany.
Department of Medicine, Nephrology, University Hospital, Goethe University, Frankfurt, Germany.
Ann Hematol. 2021 May;100(5):1159-1167. doi: 10.1007/s00277-021-04482-3. Epub 2021 Mar 11.
Acute kidney injury (AKI) complicates the clinical course of hospitalized patients by increasing need for intensive care treatment and mortality. There is only little data about its impact on AML patients undergoing intensive induction chemotherapy. In this study, we analyzed the incidence as well as risk factors for AKI development and its impact on the clinical course of AML patients undergoing induction chemotherapy. We retrospectively analyzed data from 401 AML patients undergoing induction chemotherapy between 2007 and 2019. AKI was defined and stratified according to KIDGO criteria by referring to a defined baseline serum creatinine measured on day 1 of induction chemotherapy. Seventy-two of 401 (18%) AML patients suffered from AKI during induction chemotherapy. AML patients with AKI had more days with fever (7 vs. 5, p = 0.028) and were more often treated on intensive care unit (45.8% vs. 10.6%, p < 0.001). AML patients with AKI had a significantly lower complete remission rate after induction chemotherapy and, with 402 days, a significantly shorter median overall survival (OS) (median OS for AML patients without AKI not reached). In this study, we demonstrate that the KIDGO classification allows mortality risk stratification for AML patients undergoing induction chemotherapy. Relatively mild AKI episodes have impact on the clinical course of these patients and can lead to chronic impairment of kidney function. Therefore, we recommend incorporating risk factors for AKI in decision-making considering nutrition, fluid management, as well as the choice of potentially nephrotoxic medication in order to decrease the incidence of AKI.
急性肾损伤 (AKI) 通过增加重症监护治疗和死亡率，使住院患者的临床过程复杂化。关于其对接受强化诱导化疗的 AML 患者的影响，仅有少量数据。在这项研究中，我们分析了 AKI 发展的发生率和危险因素及其对 AML 患者接受诱导化疗的临床过程的影响。我们回顾性分析了 2007 年至 2019 年间接受诱导化疗的 401 例 AML 患者的数据。根据 KIDGO 标准，通过参考诱导化疗第 1 天测量的定义基线血清肌酐来定义和分层 AKI。在诱导化疗期间，401 例 AML 患者中有 72 例（18%）患有 AKI。患有 AKI 的 AML 患者发热天数更多（7 天 vs. 5 天，p = 0.028），更常在重症监护病房接受治疗（45.8% vs. 10.6%，p < 0.001）。患有 AKI 的 AML 患者在诱导化疗后完全缓解率明显较低，中位总生存期（OS）明显较短（无 AKI 的 AML 患者的中位 OS 未达到）。在这项研究中，我们证明 KIDGO 分类允许对接受诱导化疗的 AML 患者进行死亡风险分层。相对轻微的 AKI 发作对这些患者的临床过程有影响，并可能导致肾功能慢性受损。因此，我们建议在考虑营养、液体管理以及潜在肾毒性药物选择的决策中纳入 AKI 的危险因素，以降低 AKI 的发生率。
