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The use of low doses of methotrexate during peri-cell infusion period may be a risk factor for acute kidney injury in patients subjected to hematopoietic stem cell transplantation

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Abstract

Acute kidney injury (AKI) after hematopoietic stem cell transplantation (HSCT) is associated with high mortality rates. To determine the incidence and risk factors associated with AKI in patients undergoing HSCT during the infusion period, patients admitted for HSCT from 2012 to 2015 were studied. AKI was classified according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria. We analyzed the main comorbidities, underlying conditions, types of transplant, preparative regimens, and use of potentially nephrotoxic drugs as risk factors for AKI. Among the 180 patients (median age 53 years), 69 (36.5%) developed AKI (23 KDIGO 1, 28 KDIGO 2, and 18 KDIGO 3), 49 (50.0%) undergoing allogeneic and 20 (22.3%) autologous transplantation, and 18 (9.4%) required dialysis. The main comorbidities were hypertension (38; 19.8%), and diabetes (19; 9.9%). The median pre-transplant creatinine was 0.7 mg/dl. Twenty-one patients died (10.9%). The risk factors for AKI in allogeneic HSCT were as follows: baseline estimated glomerular filtration rate (eGFR) (RR 1.12 (1.02–1.22), p = 0.019), use of vasopressors (RR 3.72 (2.20–6.29), p < 0.001), and use of methotrexate (RR 1.83 (1.08–3.11), p = 0.025). Male gender (RR 5.91 (1.65–21.16), p = 0.006), baseline eGFR (RR 1.22 (1.04–1.43), p = 0.011), and use of aminoglycosides (RR 3.92 (1.06–14.44), p = 0.041) were the risk factors for AKI associated with autologous HSCT. During hospitalization for HSCT, AKI was a common problem. The use of a low dose of methotrexate to prevent graft versus host disease was associated with its occurrence.

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Authors and Affiliations

  1. Hospital Israelita Albert Einstein, São Paulo, Brazil

    Fernanda Toledo Piza Ferraz

  2. Institute of Education and Research, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Alexandre Rodrigues Marra

  3. Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Nelson Hamerschlak

  4. Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Marcelino de Souza Durão Junior

  5. Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil

    Marcelino de Souza Durão Junior

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  1. Fernanda Toledo Piza Ferraz
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  2. Alexandre Rodrigues Marra
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  3. Nelson Hamerschlak
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  4. Marcelino de Souza Durão Junior
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Correspondence to Marcelino de Souza Durão Junior.

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The authors declare that they have no conflicts of interest.

Ethical approval

The hospital’s Institutional Review Board (under number 1.370.103) approved the study protocol, and the study was in accordance with the current version of the Helsinki Declaration.

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Due to the nature of the study, based on a retrospective review of medical charts, the informed consent form (ICF) for patients was waived.

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Ferraz, F.T.P., Marra, A.R., Hamerschlak, N. et al. The use of low doses of methotrexate during peri-cell infusion period may be a risk factor for acute kidney injury in patients subjected to hematopoietic stem cell transplantation. Ann Hematol 99, 627–633 (2020). https://doi.org/10.1007/s00277-020-03928-4

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  • DOI: https://doi.org/10.1007/s00277-020-03928-4

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