Predictors and outcome of acute kidney injury in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome

Amit Lahoti, Hagop Kantarjian, Abdulla K. Salahudeen, Farhad Ravandi, Jorge E. Cortes, Stefan Faderl, Susan O'Brien, William Wierda, Gloria N. Mattiuzzi

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Acute kidney injury (AKIis a common complication in the treatment of patients with acute myelogenous leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS), but, to the authors' knowledge, its clinical relevance has not been detailed to date. The objective of the current study was to identify the incidence, predictors, and outcome for AKI in patients with AML and HR-MDS. METHODS: Data were analyzed from 537 patients with AML or HR-MDS undergoing induction chemotherapy from 1999 to 2007. Predictors for AKI were identified by logistic regression. Eight-week mortality of patients was estimated by the Kaplan-Meier method stratified by the RIFLE criteria, a novel multilevel classification system for AKI based on the percent rise in serum creatinine from baseline (Risk, >50%; Injury, >100%; and Failure, >200% or requiring dialysis). RESULTS: A total of 187 patients (36%) developed AKI. Significant independent risk factors for AKI included the following: age ≥55 years (odds ratio [OR], 1.8), mechanical ventilation (OR, 16), use of vancomycin (OR, 2.3), diuretics (OR, 3.0), amphotericin B lipid formulation (OR, 2.7), vasopressors (OR, 4.9), leukopenia (OR, 1.9), hypoalbuminemia (OR, 1.4), and use of non-fludarabine-based chemotherapy (OR, 2.7). The 8-week mortality rates were 3.8%, 13.6%, 19.6%, and 61.7% for the non-RIFLE, Risk, Injury, and Failure categories, respectively. Patients requiring dialysis (8%) had a median survival of 33 days. Survival of patients who achieved complete remission was favorable, regardless of degree of AKI. CONCLUSIONS: The RIFLE classification for AKI appears to have prognostic utility in predicting mortality in patients with AML or HR-MDS. Relatively mild elevations in creatinine are associated with higher mortality. Strategies to avoid nephrotoxic drugs or fluid overload may be of benefit.

Original languageEnglish (US)
Pages (from-to)4063-4068
Number of pages6
JournalCancer
Volume116
Issue number17
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

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Myelodysplastic Syndromes
Acute Kidney Injury
Acute Myeloid Leukemia
Odds Ratio
Mortality
Dialysis
Creatinine
Hypoalbuminemia
Induction Chemotherapy
Survival
Wounds and Injuries
Leukopenia
Amphotericin B
Vancomycin
Artificial Respiration
Diuretics
Logistic Models
Lipids
Drug Therapy
Incidence

Keywords

  • Acute kidney failure
  • Acute myeloid leukemia
  • Dialysis
  • Logistic models
  • Myelodysplastic syndrome

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Lahoti, A., Kantarjian, H., Salahudeen, A. K., Ravandi, F., Cortes, J. E., Faderl, S., ... Mattiuzzi, G. N. (2010). Predictors and outcome of acute kidney injury in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome. Cancer, 116(17), 4063-4068. https://doi.org/10.1002/cncr.25306

Predictors and outcome of acute kidney injury in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome. / Lahoti, Amit; Kantarjian, Hagop; Salahudeen, Abdulla K.; Ravandi, Farhad; Cortes, Jorge E.; Faderl, Stefan; O'Brien, Susan; Wierda, William; Mattiuzzi, Gloria N.

In: Cancer, Vol. 116, No. 17, 01.09.2010, p. 4063-4068.

Research output: Contribution to journalArticle

Lahoti, A, Kantarjian, H, Salahudeen, AK, Ravandi, F, Cortes, JE, Faderl, S, O'Brien, S, Wierda, W & Mattiuzzi, GN 2010, 'Predictors and outcome of acute kidney injury in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome', Cancer, vol. 116, no. 17, pp. 4063-4068. https://doi.org/10.1002/cncr.25306
Lahoti, Amit ; Kantarjian, Hagop ; Salahudeen, Abdulla K. ; Ravandi, Farhad ; Cortes, Jorge E. ; Faderl, Stefan ; O'Brien, Susan ; Wierda, William ; Mattiuzzi, Gloria N. / Predictors and outcome of acute kidney injury in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome. In: Cancer. 2010 ; Vol. 116, No. 17. pp. 4063-4068.
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abstract = "BACKGROUND: Acute kidney injury (AKIis a common complication in the treatment of patients with acute myelogenous leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS), but, to the authors' knowledge, its clinical relevance has not been detailed to date. The objective of the current study was to identify the incidence, predictors, and outcome for AKI in patients with AML and HR-MDS. METHODS: Data were analyzed from 537 patients with AML or HR-MDS undergoing induction chemotherapy from 1999 to 2007. Predictors for AKI were identified by logistic regression. Eight-week mortality of patients was estimated by the Kaplan-Meier method stratified by the RIFLE criteria, a novel multilevel classification system for AKI based on the percent rise in serum creatinine from baseline (Risk, >50{\%}; Injury, >100{\%}; and Failure, >200{\%} or requiring dialysis). RESULTS: A total of 187 patients (36{\%}) developed AKI. Significant independent risk factors for AKI included the following: age ≥55 years (odds ratio [OR], 1.8), mechanical ventilation (OR, 16), use of vancomycin (OR, 2.3), diuretics (OR, 3.0), amphotericin B lipid formulation (OR, 2.7), vasopressors (OR, 4.9), leukopenia (OR, 1.9), hypoalbuminemia (OR, 1.4), and use of non-fludarabine-based chemotherapy (OR, 2.7). The 8-week mortality rates were 3.8{\%}, 13.6{\%}, 19.6{\%}, and 61.7{\%} for the non-RIFLE, Risk, Injury, and Failure categories, respectively. Patients requiring dialysis (8{\%}) had a median survival of 33 days. Survival of patients who achieved complete remission was favorable, regardless of degree of AKI. CONCLUSIONS: The RIFLE classification for AKI appears to have prognostic utility in predicting mortality in patients with AML or HR-MDS. Relatively mild elevations in creatinine are associated with higher mortality. Strategies to avoid nephrotoxic drugs or fluid overload may be of benefit.",
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author = "Amit Lahoti and Hagop Kantarjian and Salahudeen, {Abdulla K.} and Farhad Ravandi and Cortes, {Jorge E.} and Stefan Faderl and Susan O'Brien and William Wierda and Mattiuzzi, {Gloria N.}",
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AU - Lahoti, Amit

AU - Kantarjian, Hagop

AU - Salahudeen, Abdulla K.

AU - Ravandi, Farhad

AU - Cortes, Jorge E.

AU - Faderl, Stefan

AU - O'Brien, Susan

AU - Wierda, William

AU - Mattiuzzi, Gloria N.

PY - 2010/9/1

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N2 - BACKGROUND: Acute kidney injury (AKIis a common complication in the treatment of patients with acute myelogenous leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS), but, to the authors' knowledge, its clinical relevance has not been detailed to date. The objective of the current study was to identify the incidence, predictors, and outcome for AKI in patients with AML and HR-MDS. METHODS: Data were analyzed from 537 patients with AML or HR-MDS undergoing induction chemotherapy from 1999 to 2007. Predictors for AKI were identified by logistic regression. Eight-week mortality of patients was estimated by the Kaplan-Meier method stratified by the RIFLE criteria, a novel multilevel classification system for AKI based on the percent rise in serum creatinine from baseline (Risk, >50%; Injury, >100%; and Failure, >200% or requiring dialysis). RESULTS: A total of 187 patients (36%) developed AKI. Significant independent risk factors for AKI included the following: age ≥55 years (odds ratio [OR], 1.8), mechanical ventilation (OR, 16), use of vancomycin (OR, 2.3), diuretics (OR, 3.0), amphotericin B lipid formulation (OR, 2.7), vasopressors (OR, 4.9), leukopenia (OR, 1.9), hypoalbuminemia (OR, 1.4), and use of non-fludarabine-based chemotherapy (OR, 2.7). The 8-week mortality rates were 3.8%, 13.6%, 19.6%, and 61.7% for the non-RIFLE, Risk, Injury, and Failure categories, respectively. Patients requiring dialysis (8%) had a median survival of 33 days. Survival of patients who achieved complete remission was favorable, regardless of degree of AKI. CONCLUSIONS: The RIFLE classification for AKI appears to have prognostic utility in predicting mortality in patients with AML or HR-MDS. Relatively mild elevations in creatinine are associated with higher mortality. Strategies to avoid nephrotoxic drugs or fluid overload may be of benefit.

AB - BACKGROUND: Acute kidney injury (AKIis a common complication in the treatment of patients with acute myelogenous leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS), but, to the authors' knowledge, its clinical relevance has not been detailed to date. The objective of the current study was to identify the incidence, predictors, and outcome for AKI in patients with AML and HR-MDS. METHODS: Data were analyzed from 537 patients with AML or HR-MDS undergoing induction chemotherapy from 1999 to 2007. Predictors for AKI were identified by logistic regression. Eight-week mortality of patients was estimated by the Kaplan-Meier method stratified by the RIFLE criteria, a novel multilevel classification system for AKI based on the percent rise in serum creatinine from baseline (Risk, >50%; Injury, >100%; and Failure, >200% or requiring dialysis). RESULTS: A total of 187 patients (36%) developed AKI. Significant independent risk factors for AKI included the following: age ≥55 years (odds ratio [OR], 1.8), mechanical ventilation (OR, 16), use of vancomycin (OR, 2.3), diuretics (OR, 3.0), amphotericin B lipid formulation (OR, 2.7), vasopressors (OR, 4.9), leukopenia (OR, 1.9), hypoalbuminemia (OR, 1.4), and use of non-fludarabine-based chemotherapy (OR, 2.7). The 8-week mortality rates were 3.8%, 13.6%, 19.6%, and 61.7% for the non-RIFLE, Risk, Injury, and Failure categories, respectively. Patients requiring dialysis (8%) had a median survival of 33 days. Survival of patients who achieved complete remission was favorable, regardless of degree of AKI. CONCLUSIONS: The RIFLE classification for AKI appears to have prognostic utility in predicting mortality in patients with AML or HR-MDS. Relatively mild elevations in creatinine are associated with higher mortality. Strategies to avoid nephrotoxic drugs or fluid overload may be of benefit.

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KW - Acute myeloid leukemia

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