The use of low doses of methotrexate during peri-cell infusion period may be a risk factor for acute kidney injury in patients subjected to hematopoietic stem cell transplantation

AbstractAcute kidney injury (AKI) after hematopoietic stem cell transplantation (HSCT) is associated with high mortality rates. To determine the incidence and risk factors associated with AKI in patients undergoing HSCT during the infusion period, patients admitted for HSCT from 2012 to 2015 were studied. AKI was classified according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria. We analyzed the main comorbidities, underlying conditions, types of transplant, preparative regimens, and use of potentially nephrotoxic drugs as risk factors for AKI. Among the 180 patients (median age 53  years), 69 (36.5%) developed AKI (23 KDIGO 1, 28 KDIGO 2, and 18 KDIGO 3), 49 (50.0%) undergoing allogeneic and 20 (22.3%) autologous transplantation, and 18 (9.4%) required dialysis. The main comorbidities were hypertension (38; 19.8%), and diabetes (19; 9.9%). The median pre-transplant creatinin e was 0.7 mg/dl. Twenty-one patients died (10.9%). The risk factors for AKI in allogeneic HSCT were as follows: baseline estimated glomerular filtration rate (eGFR) (RR 1.12 (1.02–1.22),p = 0.019), use of vasopressors (RR 3.72 (2.20–6.29),p <  0.001), and use of methotrexate (RR 1.83 (1.08–3.11),p = 0.025). Male gender (RR 5.91 (1.65–21.16),p = 0.006), baseline eGFR (RR 1.22 (1.04–1.43),p = 0.011), and use of aminoglycosides (RR 3.92 (1.06–14.44),p = 0.041) were the risk factors for AKI associated with autologous HSCT. During hospitalization for...
Source: Annals of Hematology - Category: Hematology Source Type: research