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High incidence of acute kidney injury during chemotherapy for childhood acute myeloid leukemia
Author(s) -
Du Plessis Liezl,
Rassekh Shahrad Rod,
Mammen Cherry
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26915
Subject(s) - medicine , acute kidney injury , incidence (geometry) , sepsis , odds ratio , retrospective cohort study , creatinine , kidney disease , cohort , induction chemotherapy , chemotherapy , physics , optics
Background/objectives Childhood acute myeloid leukemia (AML) is a rare and heterogeneous disease. Pediatric data on the epidemiology of acute kidney injury (AKI) in AML are limited. We report on the incidence of AKI in childhood AML and the risk factors associated with AKI episodes. Methods A retrospective cohort of 53 patients (≤18 years), with de novo AML, receiving chemotherapy over a 10‐year period. All serum creatinine (SCr) levels during therapy‐related hospitalizations were assessed to stage AKI episodes as per Kidney Disease: Improving Global Outcomes criteria. Severe AKI was defined as AKI stages 2 or 3 and urine output criteria were not used. AKI risk factors were assessed independently in both cycle 1 alone and combining all chemotherapy cycles. Results AKI developed in 34 patients (64%) with multiple AKI episodes in 10 patients (46 total episodes). Twenty‐four severe AKI episodes occurred in 23 patients (43.4%) with a mean duration of 26.1 days (SD 7.3). In cycle 1, hyperleukocytosis was not predictive of AKI, but severe sepsis was an independent risk factor of severe AKI (odds ratio [OR]: 13.4; 95% CI 1.9–94.9). With cycles combined, all subjects with AKI had severe sepsis and older age (≥10 years) was associated with severe AKI (OR: 20.8; 95% CI 3.8–112.2). Conclusion There was a high incidence of AKI in our AML cohort with a strong association with older age (≥10 years) and severe sepsis. Larger prospective studies are needed to confirm the high burden of AKI and risk factors in this susceptible population.