Vol. 141 No. 2930 (2011)
An evaluation of the RIFLE criteria for acute kidney injury after myeloablative allogeneic haematopoietic stem cell transplantation
- YS Bao
- RJ Xie
- SZ Feng
- MZ Han
BACKGROUND: Patients undergoing myeloablative allogeneic haematopoietic stem cell transplantation (HSCT) have a higher incidence of acute kidney injury (AKI). RIFLE is a newly developed classification for AKI that includes three grades of severity – AKI-R, AKI-I, AKI-F.
OBJECTIVE: The purpose of this study was to analyse retrospectively major risk factors for AKI at the time of myeloablative allo-HSCT and to use the RIFLE criteria to predict mortality in myeloablative allo-HSCT.
METHODS: Renal function was evaluated in 143 patients with allo-HSCT by RIFLE criteria in order to assess the incidence, risk factors and mortality rate of various degrees of AKI.
RESULTS: The results of this study showed that patients with hepatic veno-occlusive disease (HVOD) have a higher incidence of AKI-F than those without HVOD (P = 0.002). The incidence of AKI-I and AKI-F in patients with grade III-IV acute graft-versus-host disease (aGVHD) and increased total bilirubin was significantly higher than in those without (P = 0.001, P <0.001). HVOD was an independent risk factor of AKI-F (OR 5.058, 95% CI 1.317–19.424, P = 0.018), and increased total bilirubin was an independent risk factor for AKI-F (OR 5.126, 95% CI 1.403–18.998, P = 0.014). Worsening RIFLE category was associated with increased mortality of the patients in the 100 days post-transplant (P = 0.003). In addition, 180-day survival of patients in different AKI classes was significantly different (P = 0.0095).
CONCLUSION: AKI is common in patients with myeloablative allo-HSCT and is associated with increased risk of death. The RIFLE criteria appear to be an important tool for stratification of these patients on the basis of death risk.
- Hahn T, Rondeau C, Shaukat A, et al. Acute renal failure requiring dialysis after allogeneic blood and marrow transplantation identifies very poor prognosis patients. Bone Marrow Transplant. 2003;32:405–10.
- CR Parikh, SG Coca. Acute renal failure in hemotopietic cell transplantation. Kidney Int. 2006;69:430–5.
- Bellomo R, Ronco C, Kellum JA, et al. the ADQI workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–R212.
- Bell M, Liljestam E, Granath F, et al. Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria. Nephrol Dial Transplant. 2005;20:354–60.
- Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care. 2006;10:R73.
- Kuitunen A, Vento A, Suojaranta-Ylinen R, et al. Acute renal failure after cardiac surgery: Evaluation of the RIFLE classification. Ann Thorac Surg. 2006;81:542–6.
- Levey AS, Coresh J, Balk E, et al. National Kidney Foundation: National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med. 2003;139:137–47.
- McDonald GB, Sharma P, Matthews DE, et al. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors. Hepatology. 1984;4:116–22.
- Gruss E, Bernis C, Tomas JF, et al. Acute renal failure in patients following bone marrow transplantation: prevalence, risk factor and outcome. Am J Nephrol. 1995;15:473–9.
- Parikh CR, McSweeney PA, Korular D, et al. Renal dysfunction in allogeneic hematopoietic cell transplantation. Kidney Int. 2002;62:566–73.
- Hingorani SR, Guthrie K, Batchelder A, et al. Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factor. Kidney Int. 2005;67:272–7.
- Parikh CR, Schrier RW, Storer B, et al. Comparison of ARF after myeloablative and nonmeyloablative hematopoietic cell transplantation. Am J kidney Dis. 2005;45:502–9.
- Zager RA, O’Quigley J, Zager BK, et al. Acute renal failure following bone marrow transplantation: A retrospective study of 272 patients. Am J Kidney Dis. 1989;13:210–6.
- Liu H, Ding JH, Liu BC, et al. Early renal injury after nonmyeoloablative allogeneic peripheral blood stem cell transplantation in patient with chronic myelocytic leukemia. Am J Nephrol. 2007;27:336–41.
- Caliskan Y, Besisik SK, Sargin D, et al. Early renal injury after myeloablative allogeneic and autologous hematopoietic cell transplantation. Bone Marrow Transplant. 2006;38:141–7.
- Rao PS. Nephrotic sydrome in patients with peripheral blood stem cell transplant. Am J Kidney Dis. 2005;45:780–5.
- Panoskaltsis-Mortari A, Price A, Hermanson JR, et al. In vivo imaging of graft-versus-host-disease in mice. Blood. 2004;103:3590–8.
- Zager RA. Acute renal failure in the setting of bone marrow transplantation. Kidney Int. 1994;46:1443–58.
- Kist-van Holthe J, Goedvolk CA, Brand R, et al. Prospective study of renal insufficiency after bone marrow transplantation. Pediatr Nephrol. 2002;17:1032–7.
- H Liu, Y-F Li, BC Liu, et al. A multicenter, retrospective study of acute kidney injury in adult patients with nonmyeloablative hematopoietic SCT. Bone Marrow Transplant. 2010;45:153–8.
- Parikh CR, McSweeney P, Schrier RW. Acute renal failure independently predicts mortality after myeloablative allogeneic hematopoietic cell transplant. Kidney Int. 2005;67:1999–2005.
- Lopes JA, Jorge S, Silva S, et al. Prognostic utility of the acute kidney injury network criteria for acute kidney injury in myeloablative haematopoietic cell transplantation. Bone Marrow Transplant. 2007;40:1005–6.
- Kersting S, Dorp SV, Theobald M, et al. Acute renal failure after nonmyeloablative stem cell transplantation in adults. Biol Blood Marrow Transplant. 2008;14:125–31.
- JA Lopes, S Jorge, S Goncolves, et al. Contemporary analysis of the influence of acute kidney injury (AKI) after myeloablative hematopoietic cell transplantation on long-term patients’ survival. Bone Marrow Transplant. 2008;42:139–41.
- Lopes JA, Jorge S, Silva S, et al. Acute renal failure following myeloablative autologous and allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2006;38:707.
- Weiss AS, Sandmaier BM, Storer B, et al. Chronic kidney disease following nonmyeloablative hematopoietic cell transplantation. Am J Transplant. 2006;6:89–94.
- Delgado J, Cooper N, Thomson K, et al. The importance of age, fludarabine, and total body irradiation in the incidence and severity of chronic renal failure after allogeneic hematopoietic cell transplantation. Biol Blood Marrow transplant. 2006;12:75–83.