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Abstract: SA-PO151

AKI Treated With Kidney Replacement Therapy in Allogeneic Hematopoietic Stem Cell Transplantation (aHSCT) Patients Admitted to the Intensive Care Unit: Incidence, Risk Factors, and Outcomes

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Kim, Helena, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Ali, Rafia W., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Short, Samuel, University of Vermont College of Medicine, Burlington, Vermont, United States
  • Shapiro, Roman, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
  • Soiffer, Robert, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
  • Defilipp, Zachariah, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Thomas, Charlotte, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Park, Isabel, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Acute kidney injury (AKI) following allogeneic hematopoietic stem cell transplantation (aHSCT) is a common complication associated with substantial morbidity and mortality. Those who develop AKI treated with kidney replacement therapy (AKI-KRT) have even higher mortality. Few studies have investigated the incidence, risk factors, and outcomes associated with AKI-KRT in critically ill patients following aHSCT.

Methods

We performed a retrospective cohort study of 179 patients admitted to an ICU within 1 year following aHSCT (transplanted between 2013 and 2019) at two academic medical centers in Boston, MA. Data on demographics, comorbidities, lab values, medications, and clinical outcomes were obtained through both automated and manual review of medical records. We assessed independent risk factors for development of AKI-KRT using multivariable logistic regression. We assessed mortality during hospital admission and at 3- and 6-months after ICU admission according to maximum KDIGO AKI stage during ICU admission.

Results

A total of 42 of 179 patients (23.5%) developed AKI-KRT during ICU admission. Independent risk factors for AKI-KRT included veno-occlusive disease (VOD) and thrombotic microangiopathy (TMA) prior to ICU admission, receipt of invasive mechanical ventilation on ICU admission, and admission to the ICU within 180 days following aHSCT (Figure 1A). Mortality increased with higher AKI stage, and was highest in those with AKI-KRT, reaching 78.6% during hospitalization and 88.1% at 6 months (Figure 1B).

Conclusion

Among aHSCT patients admitted to the ICU, independent risk factors for AKI-KRT included VOD, TMA, receipt of invasive mechanical ventilation, and admission to the ICU within 180 days following aHSCT. Nearly 90% of patients who developed AKI-KRT died with 6 months of ICU admission.