Abstract: SA-PO172
Kidney Recovery Prognosis after Allogeneic Hematopoietic Stem-Cell Transplantation
Session Information
- Onconephrology: Kidney Outcomes during Cancer Treatment and Nephropathies
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Tsai, Ping-Chi, National Taiwan University Hospital, Taipei, Taiwan
- Ko, Bor-Sheng, National Taiwan University College of Medicine, Taipei, Taiwan
- Huang, Jenq-wen, National Taiwan University Hospital, Taipei, Taiwan
- Su, Chi-Ting, National Taiwan University College of Medicine, Taipei, Taiwan
Background
Predictors of renal dysfunction should be thoroughly investigated to prevent compromising the success of HSCT in treating malignant and non-malignant hematological diseases. We aimed to determine the factors and effects of acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD) in patients receiving HSCT and investigate the impacts of the trajectory of renal recovery on outcomes.
Methods
We conducted a retrospective study of adult patients receiving allo-HSCT between 2015 and 2023. We identified incident AKI, AKD, and CKD as defined by changes in serum creatinine (sCr) levels based on the KDIGO criteria and ADQI consensus. Severe AKI and AKD were defined as a 100% increase in sCr within 7 and 90 days, respectively. Kidney recovery was based on the AKI resolution and subsequent sCr measurements below 1.5× the baseline at different timeframe. Multivariate Cox regression was used to assess known risk factors.
Results
The participants were 805 patients (mean age; 50.3 years; men; 53.3%; and median follow-up; 2.3 years). The incidence rates of AKI and AKD after 100 days of treatment were 53.8% and 65.3%, respectively. The cumulative incidence of CKD was 23.4%, whereas the non-relapse mortality was 11.8%. Severe AKI was independently associated with higher non-relapse mortality (hazard ratio [HR]; 2.01) and recovery after 3, 7, and 90 days of AKD were similar (HR; 2.90, p=0.004; HR; 2.39, p=0.01; and HR; 3.41, p=0.001, respectively). Non-recovery of AKI by 90 days was a risk factor for CKD (HR; 5.65/5.32, p<0.001), whereas AKI recovery by 3 and 7 days were not risk factors. Male sex, diabetes mellitus, hemorrhagic cystitis (HR; 2.40), and acute dialysis after HSCT (HR; 8.89) conferred higher risk of CKD incidence. Exposure to various nephrotoxic agents (HR; 1.76, p<0.001) increased risk of AKI. Cyclosporine levels was associated with AKI (HR for 1 standard deviation (SD) increase; 1.27, p<0.001) and exerted negative effect on recovery at 3 days (odds ratio for 1 SD increase; 1.52, p<0.001).
Conclusion
Recovery patterns of AKI stratify the risk of CKD and mortality. Moreover, the results highlighted cyclosporine levels, nephrotoxic agents, and hemorrhagic cystitis for further monitoring of the AKI-CKD continuum. Thus, transition from post-AKI to post-AKD and CKD should be prevented for patients receiving HSCT.