Acute kidney injury in critically ill patients with haematological malignancies: results of a multicentre cohort study from the Groupe de Recherche en Reanimation Respiratoire en Onco-Hematologie

作者：Darmon Michael^*; Vincent Francois; Canet Emmanuel; Mokart Djamel; Pene Frederic; Kouatchet Achille; Mayaux Julien; Nyunga Martine; Bruneel Fabrice; Rabbat Antoine; Lebert Christine; Perez Pierre; Renault Anne; Meert Anne Pascale; Benoit Dominique; Hamidfar Rebecca; Jourdain Merce; Schlemmer Benoit; Chevret Sylvie; Lemiale Virginie; Azoulay Elie

来源：Nephrology Dialysis Transplantation, 2015, 30(12): 2006-2013.

DOI：10.1093/ndt/gfv372

• acute kidney injury
• ICU
• prognosis
• renal replacement therapy
• tumour lysis syndrome

Background. Cancer patients are at high risk for acute kidney injury (AKI), which is associated with high morbidity and mortality. We sought to appraise the incidence, risk factors, and outcome of AKI in a large multicentre cohort study of critically ill patients with haematological malignancies.
Methods. We used a retrospective analysis of a prospectively collected database. The study was carried out in 17 university or university-affiliated centres in France and Belgium between 2010 and 2012. AKI was defined according to the Acute Kidney Injury Network (AKIN) definition.
Results. Of the 1011 patients admitted into the intensive care unit (ICU) during the study period, 1009 were included in this study. According to the AKIN definition, 671 patients (66.5%) developed an AKI during their ICU stay, of which 258 patients (38.4%) were AKI stage 1, 75 patients (11.2%) AKI stage 2 and 338 patients (50.4%) AKI stage 3. After adjustment for confounders, main adverse risk factors of AKI were older age, severity [non-renal Sequential Organ Failure Assessment (SOFA)], history of hypertension, tumour lysis syndrome, exposure to nephrotoxic agents and myeloma. Hospital mortality was 44.3% in patients with AKI and 25.4% in patients without AKI (P < 0.0001). After adjustment for confounders, AKI was independently associated with hospital mortality [OR 1.65 (95% CI 1.19-2.29)]. Overall, 271 patients required renal replacement therapy (RRT), of whom 57.2% died during their hospital stay as compared with 31.2% (P < 0.0001) in those not requiring RRT.
Conclusion. Two-thirds of critically ill patients with haematological malignancies developed AKI. Hospital mortality in this population of patients developing AKI or requiring RRT is close to that in general ICU population.

• 出版日期2015-12