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Comparative Study
. 2015 Dec;30(12):2006-13.
doi: 10.1093/ndt/gfv372.

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

Michael Darmon  1 , François Vincent  2 , Emmanuel Canet  3 , Djamel Mokart  4 , Frédéric Pène  5 , Achille Kouatchet  6 , Julien Mayaux  7 , Martine Nyunga  8 , Fabrice Bruneel  9 , Antoine Rabbat  5 , Christine Lebert  10 , Pierre Perez  11 , Anne Renault  12 , Anne-Pascale Meert  13 , Dominique Benoit  14 , Rebecca Hamidfar  15 , Mercé Jourdain  16 , Benoit Schlemmer  3 , Sylvie Chevret  3 , Virginie Lemiale  3 , Elie Azoulay  3
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Comparative Study

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

Michael Darmon et al. Nephrol Dial Transplant. 2015 Dec.

Abstract

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.

Keywords: ICU; acute kidney injury; prognosis; renal replacement therapy; tumour lysis syndrome.

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Figures

FIGURE 1:
FIGURE 1:
Flow chart of patients admitted during the study period.
FIGURE 2:
FIGURE 2:
Cumulative survival according to AKI and its severity (no AKI: dark blue line; AKI stage 1: light blue line; AKI stage 2: light green line; AKI stage 3: deep green line). Comparison according to log-rank test; P < 0.0001.
FIGURE 3:
FIGURE 3:
Cumulative survival according to RRT requirement (no RRT: dark line; RRT: grey line). Comparison according to log-rank test; P < 0.0001.
See this image and copyright information in PMC

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