Faculty Collaboration Database

Correlates and Outcomes of Early Acute Kidney Injury after Hematopoietic Cell Transplantation. Am J Med Sci 2021 Jul;362(1):72-77

Date

04/05/2021

Pubmed ID

33812909

DOI

10.1016/j.amjms.2021.03.013

Scopus ID

2-s2.0-85105320844 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: Patients undergoing hematopoietic cell transplantation (HCT) are at high risk for acute kidney injury (AKI). The etiology of AKI is often multifactorial and includes exposure to antibiotics and calcineurin inhibitors (CNI) for prevention of graft versus host disease.

METHODS: This is a retrospective, single center study which evaluated patients undergoing inpatient HCT at Froedtert Memorial Hospital, Milwaukee, Wisconsin from Jan 1 to Dec 31, 2016. AKI was defined as an increase in serum creatinine > 0.3 mg/dL from baseline value.

RESULTS: The total number of patients included in the study was 280, 64 had AKI and 216 were in the non-AKI group. AKI was noted in 23% patients. Exposure to CNI or vancomycin accounted for the majority of the cases (82%). The median pre-AKI vancomycin trough was elevated in the AKI group at 21.3 mcg/mL (range: 17.4-24.4 mcg/mL) while the pre-AKI CNI trough was lower in the AKI group at 12.3 ng/mL (range: 8.7-14.7 ng/mL).There were also a higher number of ICU transfers (19%) and higher 100 day mortality (15.6%) in the AKI group.

CONCLUSION: AKI is a frequent complication following HCT and is associated with a higher risk of ICU transfer and higher mortality post HCT. While a higher vancomycin trough level may be indicative of a higher risk of AKI, the risk following CNI exposure may not be related to trough levels alone. There may be underlying pharmacogenetic factors which may alter the risk of AKI with CNI use.

Author List

Bhasin B, Ber Ce P, Szabo A, Chhabra S, D'Souza A

Authors

Anita D'Souza MD Associate Professor in the Medicine department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Adaptor Proteins, Signal Transducing
Aged
Anti-Bacterial Agents
Case-Control Studies
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Vancomycin