Background: Acute kidney disease (AKD) is a recent definition reflecting ongoing physiopathological processes of an acute renal injury (AKI). Information on AKD in hematopoietic stem cell transplant (HSCT) is scarce and there is no available data on long-term outcomes. We aimed to determine the cumulative incidence of AKD in the first 100 days after HSCT; to identify risk factors for AKD in HSCT; and to determine the impact of AKD in 3-year overall survival and relapse-free survival in HSCT. Methods: A retrospective cohort study was conducted, considering AKD when AKI was present and the patient continued to meet the KDIGO criteria (creatinine and/or urinary output criteria) for 7 days or more. Survival analysis methods considering competing events were used for risk factors and disease-free survival, Cox proportional regression for overall survival, and stepwise regression methods for multivariable models. Results: We enrolled 422 patients. AKD incidence was 22.9% (95% CI: 19.2–27.4%). Higher body mass index (HR: 1.05, 95% CI 1.01–1.10;p= 0.034), HCT-CI score ≥ 2 (HR: 1.83, 95% CI 1.11–3.13;p= 0.027), allogeneic transplantation (HR:2.03, 95% CI 1.26–3.33;p= 0.004), higher C-reactive protein (HR:1.01, 95% CI 1.01–1.02;p< 0.001), and exposure to nephrotoxic drugs (HR: 4.81, 95% CI 1.54–4.95;p= 0.038) were independently associated with AKD. AKD had a significant impact on overall survival (HR: 1.75; 95% CI 1.27–2.39;p= 0.001). Conclusion: An awareness of the risk factors for AKD allows the identification of high-risk patients, enabling the timely implementation of preventive measures to alleviate the progression and impact of the disease.
背景：急性肾脏病（AKD）是反映急性肾损伤（AKI）持续病理生理过程的新近定义。关于造血干细胞移植（HSCT）后AKD的信息较少，且缺乏长期结局数据。本研究旨在确定HSCT后100天内AKD的累积发病率；识别HSCT中AKD的危险因素；并评估AKD对HSCT患者3年总生存期和无复发生存期的影响。方法：开展一项回顾性队列研究，将AKI持续存在且患者符合KDIGO标准（肌酐和/或尿量标准）达7天或以上者定义为AKD。采用考虑竞争风险的生存分析方法分析危险因素和无病生存期，使用Cox比例风险回归分析总生存期，并采用逐步回归方法构建多变量模型。结果：共纳入422例患者。AKD发病率为22.9%（95% CI：19.2–27.4%）。较高的体重指数（HR：1.05，95% CI 1.01–1.10；p=0.034）、HCT-CI评分≥2（HR：1.83，95% CI 1.11–3.13；p=0.027）、异基因移植（HR：2.03，95% CI 1.26–3.33；p=0.004）、较高的C反应蛋白水平（HR：1.01，95% CI 1.01–1.02；p<0.001）以及肾毒性药物暴露（HR：4.81，95% CI 1.54–4.95；p=0.038）均与AKD独立相关。AKD对总生存期有显著影响（HR：1.75；95% CI 1.27–2.39；p=0.001）。结论：认识AKD的危险因素有助于识别高危患者，从而及时采取预防措施以减轻疾病进展及其影响。
肿瘤(癌症)患者之家