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. 2021 May;100(5):1159-1167.
doi: 10.1007/s00277-021-04482-3. Epub 2021 Mar 11.

Acute kidney injury adversely affects the clinical course of acute myeloid leukemia patients undergoing induction chemotherapy

Olivier Ballo #  1 , Fagr Eladly #  2 , Stefan Büttner  3 , Jan Alexander Stratmann  2 , Sarah Rudolf  3 , Uta Brunnberg  2 , Eva-Maria Kreisel  2 , Björn Steffen  2   4 , Sebastian Wagner  2   4 , Fabian Finkelmeier  5 , Hubert Serve  2   4 , Christian H Brandts  6   7   8
Affiliations

Acute kidney injury adversely affects the clinical course of acute myeloid leukemia patients undergoing induction chemotherapy

Olivier Ballo et al. Ann Hematol. 2021 May.

Abstract

Acute kidney injury (AKI) complicates the clinical course of hospitalized patients by increasing need for intensive care treatment and mortality. There is only little data about its impact on AML patients undergoing intensive induction chemotherapy. In this study, we analyzed the incidence as well as risk factors for AKI development and its impact on the clinical course of AML patients undergoing induction chemotherapy. We retrospectively analyzed data from 401 AML patients undergoing induction chemotherapy between 2007 and 2019. AKI was defined and stratified according to KIDGO criteria by referring to a defined baseline serum creatinine measured on day 1 of induction chemotherapy. Seventy-two of 401 (18%) AML patients suffered from AKI during induction chemotherapy. AML patients with AKI had more days with fever (7 vs. 5, p = 0.028) and were more often treated on intensive care unit (45.8% vs. 10.6%, p < 0.001). AML patients with AKI had a significantly lower complete remission rate after induction chemotherapy and, with 402 days, a significantly shorter median overall survival (OS) (median OS for AML patients without AKI not reached). In this study, we demonstrate that the KIDGO classification allows mortality risk stratification for AML patients undergoing induction chemotherapy. Relatively mild AKI episodes have impact on the clinical course of these patients and can lead to chronic impairment of kidney function. Therefore, we recommend incorporating risk factors for AKI in decision-making considering nutrition, fluid management, as well as the choice of potentially nephrotoxic medication in order to decrease the incidence of AKI.

Keywords: Acute kidney failure; Acute myeloid leukemia; Induction chemotherapy; Intensive care treatment; Survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for overall survival (OS). OS of AML patients without AKI (solid line) and AML patients with KDIGO stage 1 AKI (dashed line), KDIGO stage 2 AKI (dotted line), and KDIGO stage 3 AKI (dotted and dashed line)
See this image and copyright information in PMC

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