Author:
Rodrigues Natacha,Costa Claudia,Branco Carolina,Martins Carlos,Lopes José António
Abstract
Abstract
Background
Autologous hematopoietic stem cell transplant plays an important role in multiple myeloma (MM) treatment. Increasing incidence of MM and growing awareness of acute kidney injury (AKI) as a complication of hematopoietic stem cell transplant results in the need to better understand AKI in these patients. We aimed to evaluate incidence, risk factors and 5-year prognostic impact of AKI in MM patients undergoing autologous hematopoietic stem cell transplant.
Methods
Retrospective cohort study. AKI was defined by the KDIGO classification using creatinine and urinary output criteria. We used survival analysis methods considering competing events for risk factors and disease-free survival, Cox proportional regression for overall survival and stepwise regression methods for multivariable models.
Results
We analyzed data regarding 143 patients. The cumulative incidence of AKI and moderate-to-severe AKI was 49.7% and 14.1%, respectively. Factors with independent impact on AKI were obesity (HR: 1.83, 95% CI 1.07–3.11; p = 0.026), Hematopoietic cell transplantation—specific comorbidity index (HCT-CI) ≥ 2 (HR: 1.85, 95% CI 1.08–3.17), chronic kidney disease (CKD) (HR: 2.06, 95% CI 1.05–4.04), amyloidosis (HR: 2.25, 95% CI 1.25–4.06), mucositis grade 3–4 (HR: 2.19, 95% CI 1.25–3.86) and exposure to nephrotoxic drugs (HR: 2.0856, 95% CI 1.04–4.19). Moderate-to-severe AKI had an impact (HR: 1.62, 95% CI 1.15–2.31) on 5-year overall survival.
Conclusion
Acute kidney injury affects almost half of MM patients undergoing autologous hematopoietic stem cell transplantation, and reduction in urinary output allows early diagnosis in almost a quarter of the patients. Obesity, HCT-CI ≥ 2, CKD, amyloidosis, mucositis grade 3–4 and exposure to nephrotoxic drugs are significant risk factors. Moderate-to-severe AKI is associated with lower 5-year overall survival.
Graphical abstract
Publisher
Springer Science and Business Media LLC
Reference30 articles.
1. Huang J, Chan SC, Lok V et al (2022) The epidemiological landscape of multiple myeloma: a global cancer registry estimate of disease burden, risk factors, and temporal trends. Lancet Haematol 9:e670–e677
2. Cowan AJ, Allen C, Barac A, Basaleem H, Bensenor I, Curado MP et al (2018) Global burden of multiple myeloma: a systematic analysis for the global burden of disease study 2016. JAMA Oncol 4:1221–1227
3. Kazandjian D (2016) Multiple myeloma epidemiology and survival: a unique malignancy. Semin Oncol 43(6):676–681
4. Gameiro J, Neves J, Rodrigues N, Bekerman C, Melo M, Pereira M et al (2016) Acute kidney injury, long-term renal function and mortality in patients undergoing major abdominal surgery: a cohort analysis. Clin Kidney J 9(2):192–200
5. Pereira M, Rodrigues N, Godinho I, Gameiro J, Neves M, Gouveia J et al (2017) Acute kidney injury in patients with severe sepsis or septic shock: a comparison between the ‘risk, injury, failure, loss of kidney function, end-stage kidney disease’ (RIFLE), acute kidney injury network (AKIN) and kidney disease: improving global outcomes (KDIGO) classifications. Clin Kidney J 10(3):332–340