Acute kidney injury in patients with newly diagnosed high-grade hematological malignancies: impact on remission and survival.

Abstract

BACKGROUND:

Optimal chemotherapy with minimal toxicity is the main determinant of complete remission in patients with newly diagnosed hematological malignancies. Acute organ dysfunctions may impair the patient's ability to receive optimal chemotherapy.

DESIGN AND METHODS:

To compare 6-month complete remission rates in patients with and without acute kidney injury (AKI), we collected prospective data on 200 patients with newly diagnosed high-grade malignancies (non-Hodgkin lymphoma, 53.5%; acute myeloid leukemia, 29%; acute lymphoblastic leukemia, 11.5%; and Hodgkin disease, 6%).

RESULTS:

According to RIFLE criteria, 137 (68.5%) patients had AKI. Five causes of AKI accounted for 91.4% of cases: hypoperfusion, tumor lysis syndrome, tubular necrosis, nephrotoxic agents, and hemophagocytic lymphohistiocytosis. Half of the AKI patients received renal replacement therapy and 14.6% received suboptimal chemotherapy. AKI was associated with a lower 6-month complete remission rate (39.4% vs. 68.3%, P<0.01) and a higher mortality rate (47.4% vs. 30.2%, P<0.01) than patients without AKI. By multivariate analysis, independent determinants of 6-month complete remission were older age, poor performance status, number of organ dysfunctions, and AKI.

CONCLUSION:

AKI is common in patients with newly diagnosed high-grade malignancies and is associated with lower complete remission rates and higher mortality.

• Authors: Emmanuel Canet, Lara Zafrani, Jerome Lambert, Catherine Thieblemont, Lionel Galicier, David Schnell, Emmanuel Raffoux, Etienne Lengline, Sylvie Chevret, Michael Darmon, Elie Azoulay
• Journal: PloS one (PLoS One) Vol. 8 Issue 2 Pg. e55870 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 23457485 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents

Topics

• Acute Kidney Injury (complications, mortality, pathology, therapy)
• Adult
• Antineoplastic Agents (therapeutic use)
• Female
• Hematologic Neoplasms (complications, mortality, pathology, therapy)
• Humans
• Kidney (pathology)
• Male
• Middle Aged
• Multivariate Analysis
• Prospective Studies
• Remission Induction
• Renal Replacement Therapy
• Survival Rate
• Treatment Outcome