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Risk factors for severe acute kidney injury after pediatric hematopoietic cell transplantation

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Abstract

Background

Acute kidney injury (AKI) is common after hematopoietic cell transplantation (HCT) and is associated with poorer outcomes. Risk factors for AKI after pediatric HCT are not fully understood. The study objective was to assess unique risk factors for AKI in the HCT population and evaluate post-HCT AKI patterns.

Methods

We conducted a retrospective cohort study of patients < 21 years of age who underwent HCT at Seattle Children’s Hospital/Fred Hutchinson Cancer Center from September 2008 to July 2017 (n = 484). We defined AKI using KDIGO criteria. We collected demographics, baseline HCT characteristics, post-HCT complications, and mortality. Multinomial logistic regression was used to estimate association between AKI and potential risk factors. We used adjusted Cox proportional hazard ratios to evaluate differences in mortality.

Results

One hundred and eighty-six patients (38%) developed AKI. Seventy-nine (42%) had severe AKI and 27 (15%) required kidney replacement therapy. Fluid overload was common in all groups and 67% of those with severe AKI had > 10% fluid overload. Nephrology was consulted in less than 50% of those with severe AKI. In multivariable analysis, risk of severe AKI was lower in those taking a calcineurin inhibitor (CNI). Risk of death was higher in severe AKI compared to no AKI (RR 4.6, 95% CI 2.6–8.1).

Conclusions

AKI and fluid overload are common in pediatric patients after HCT. Severe AKI occurred less often with CNI use and was associated with higher mortality. Future interventions to reduce AKI and its associated complications such as fluid overload are approaches to reducing morbidity and mortality after HCT.

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Acknowledgements

We thank our colleagues from the Department of Pediatrics, Division of Nephrology and Division of Hematology–Oncology and Bone Marrow Transplant who provided insight and expertise that greatly assisted the research. We would also like to specifically acknowledge Agne Taraseviciute, MD, who assisted in the formation of the initial study design.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97238, USA

    Abbie Bauer

  2. Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, USA

    Kristen Carlin

  3. Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA

    Stephen M. Schwartz

  4. Epidemiology Program, Fred Hutchinson Cancer Center, Seattle, USA

    Stephen M. Schwartz

  5. Division of Hematology Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, USA

    Meera Srikanthan

  6. Division of Hematology Oncology, Department of Pediatrics, Fred Hutchinson Cancer Center, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, USA

    Monica Thakar & Lauri M. Burroughs

  7. Division of Nephrology, Department of Pediatrics, Seattle Children’s Hospital and University of Washington, Seattle, USA

    Jodi Smith, Sangeeta Hingorani & Shina Menon

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  1. Abbie Bauer
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Correspondence to Abbie Bauer.

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Bauer, A., Carlin, K., Schwartz, S.M. et al. Risk factors for severe acute kidney injury after pediatric hematopoietic cell transplantation. Pediatr Nephrol 38, 1365–1372 (2023). https://doi.org/10.1007/s00467-022-05731-x

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