Acute Kidney Injury in Patients with Newly Diagnosed High-Grade Hematological Malignancies: Impact on Remission and Survival

作者：Canet Emmanuel^*; Zafrani Lara; Lambert Jerome; Thieblemont Catherine; Galicier Lionel; Schnell David; Raffoux Emmanuel; Lengline Etienne; Chevret Sylvie; Darmon Michael; Azoulay Elie

来源：PLos One, 2013, 8(2): e55870.

DOI：10.1371/journal.pone.0055870

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%26apos;s ability to receive optimal chemotherapy. %26lt;br%26gt;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%). %26lt;br%26gt;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%26lt;0.01) and a higher mortality rate (47.4% vs. 30.2%, P%26lt;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. %26lt;br%26gt;Conclusion: AKI is common in patients with newly diagnosed high-grade malignancies and is associated with lower complete remission rates and higher mortality.

• 出版日期2013-2-14