Acute Kidney Injury and Risk Factors in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation

Abstract

Abstract Background Acute kidney injury (AKI) is common complication of hematopoietic stem cell transplantation (HSCT) with increased mortality and morbidity. Understading the risk factors for AKI is essential. The aim of this study is to identify AKI incidence, risk factors, and prognosis in pediatric post- HSCT patients.Methods We conducted a retrospective case-control study of 278 patients who were divided into two groups: those with AKI and those without AKI (Non-AKI). The groups were compared in terms of characteristics and clinical symptoms of patients, and post-HSCT complications, nephrotoxic drug use. Logistic regression analysis was applied to determine the risk factors for AKI.Results A total of 16.9% of patients had acute kidney injury, with 8.5% requiring kidney replacement therapy. Older age (OR 1.129, 95% CI 1.061-1.200, p < .001), sinusoidal obstruction syndrome (OR 2.562, 95% CI 1.216–5.398, p = .011), hemorrhagic cystitis (OR 2.703, 95% CI 1.178–6.199, p = .016), and nephrotoxic drugs, including calcineurin inhibitors, amikacin, and vancomycin (OR 17.250, 95% CI 2.329-127.742, p < .001), were identified as significant independent risk factors for AKI following HSCT. Mortality rate and mortality due to AKI were higher in stage 3 patients than those in stage 1 and 2 AKI (p = .019, p = .007, respectively). Chronic kidney disease developed in 1 patient (0.4%), who was in stage 1 AKI (2.1%).Conclusion AKI poses a serious threat to children post-HSCT, leading to alarming rates of mortality and morbidity. To enhance outcomes and mitigate these risks, it is vital to identify AKI risk factors, adopt early preventive strategies, and closely monitor this patient group.