Andronesi Andreea, Sorohan Bogdan, Burcea Andreea, Lipan Lavinia, Stanescu Cristina, Craciun Oana, Stefan Laura, Ranete Adela, Varady Zsofia, Ungureanu Oana, Lupusoru Gabriela, Agrigoroaei Gabriela, Andronesi Danut, Iliuta Luminita, Obrisca Bogdan, Tanase Alina
Department of Nephrology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania.
Biomedicines. 2022 Jan 25;10(2):262. doi: 10.3390/biomedicines10020262.
(1) Background: Acute kidney injury (AKI) is a serious complication of hematopoietic stem cell transplantation (HSCT). (2) Methods: The aim was to identify the incidence, severity, and risk factors for AKI during the first 100 days after allo-HSCT; we performed a prospective observational study on 135 consecutive patients. (3) Results: The mean age was 38.3 ± 11.9 years (50.6% females), AKI developed in 93 patients (68.9%), the median time of appearance was 28 days, and the mean serum creatinine at the time of AKI was 1.8 ± 0.8 mg/dL. A total of 36 (38.7%) patients developed stage 1 AKI, 33 (35.5%) patients developed stage 2, and 24 (25.8%) patients developed stage 3; eight (8.6%) patients required temporary hemodialysis, and the mortality rate in these patients was 87.5%. Death was twice as frequent in the AKI subgroup, without statistical significance. Cyclosporine overdose (HR = 2.36, 95% CI: 1.45-3.85, = 0.001), tacrolimus overdose (HR = 4.72, 95% CI: 2.22-10.01, < 0.001), acute graft-versus-host disease (aGVHD) (HR = 1.96, 95% CI: 1.13-3.40, = 0.01), and CRP level (HR = 1.009, 95% CI: 1.007-1.10, < 0.001) were independent risk factors for AKI. Sepsis (HR = 5.37, 95% CI: 1.75-16.48, = 0.003) and sinusoidal obstruction syndrome (HR = 5.10, 95% CI: 2.02-12.85, = 0.001) were found as independent risk factors for AKI stage 3. (4) Conclusions: AKI occurs with high incidence and increased severity after allo-HSCT. Careful monitoring of calcineurin inhibitors and proper management of sepsis may reduce this risk.
(1) 背景：急性肾损伤（AKI）是造血干细胞移植（HSCT）的严重并发症。(2) 方法：目的是确定异基因造血干细胞移植后100天内AKI的发生率、严重程度及危险因素；我们对135例连续患者进行了前瞻性观察研究。(3) 结果：平均年龄为38.3±11.9岁（女性占50.6%），93例患者（68.9%）发生AKI，中位出现时间为28天，AKI发生时的平均血清肌酐为1.8±0.8mg/dL。共有36例（38.7%）患者发生1期AKI，33例（35.5%）患者发生2期，24例（25.8%）患者发生3期；8例（8.6%）患者需要临时血液透析，这些患者的死亡率为87.5%。AKI亚组的死亡频率是其两倍，但无统计学意义。环孢素过量（HR = 2.36，95%CI：1.45 - 3.85，P = 0.001）、他克莫司过量（HR = 4.72，95%CI：2.22 - 10.01，P < 0.001）、急性移植物抗宿主病（aGVHD）（HR = 1.96，95%CI：1.13 - 3.40，P = 0.01）和CRP水平（HR = 1.009，95%CI：1.007 - 1.10，P < 0.001）是AKI的独立危险因素。脓毒症（HR = 5.37，95%CI：1.75 - 16.48，P = 0.003）和窦性阻塞综合征（HR = 5.10，95%CI：2.02 - 12.85，P = 0.001）被发现是3期AKI的独立危险因素。(4) 结论：异基因造血干细胞移植后AKI发生率高且严重程度增加。仔细监测钙调神经磷酸酶抑制剂并妥善处理脓毒症可能降低此风险。
