Acute Kidney Injury in Haematopoetic Stem Cell Transplantation.

Venu Madhav, Gowrugari (2013) Acute Kidney Injury in Haematopoetic Stem Cell Transplantation. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION AND AIM : Acute kidney injury is a common complication after allogenic hematopoietic stem cell transplantation (HSCT). Different studies have shown varied incidences. Aim of study was to identify the incidence and outcomes of acute kidney injury associated with allogenic hematopoietic stem cell transplant (HSCT). METHODS : 203 HSCT recipients at Christian Medical College, Vellore from Jan 2010 to Dec 2011 were studied and followed up to 12 months from the time of allogenic HSCT. Data was collected from HSCT database and Clinical workstation network. AKIN and RIFLE criteria of AKI were used to define acute kidney injury. Mortality and chronic kidney disease were primary outcome variables studied. RESULTS : The 203 allogenic HSCT recipients (172 matched related and 31 matched unrelated donors, M: F = 1.57:1; mean age 22 ± 14.5 years), had a total of 170 episodes of AKI by AKIN criteria. A minimum of one episode of AKI was observed by RIFLE criteria in 140 (69%) and AKIN criteria in 149(72.9%) patients. There was good agreement between the RIFLE (R‐34.5%, I‐24.1%, F‐ 10.3%) and AKIN classification (Stage 1‐ 38.4%, 2‐ 24.6%, 3‐ 10.3%) (K=0.75). AKI occurred at a median of 17 (2‐290) days after the HSCT. Common causes of AKI were sepsis/SIRS (34.5%), nephrotoxic antibiotic use (6.4%), Cyclosporine toxicity (18.2%) and dehydration (eg. ‐ gastroenteritis, GVHD in GI tract, 3.0%). Mortality was observed in 29.5% at the end of 1 year. SOS, Amphotericin, Sepsis, Systemic mycosis are independent risk factor for mortality. AKI is a significant risk factor for mortality (84.2% vs. 67.6%. p<0.011). Among survivors, chronic kidney disease was noted in 41.0% of patients at the end of follow up. Kaplan Meier survival analysis of mortality with severity of renal dysfunction demonstrates a stepwise incremental risk according to the AKIN classification (p<0.001). CONCLUSIONS : AKI is very common after allogenic HSCT and accounts for significant mortality and morbidity among these patients. AKIN classification of AKI has prognostic significance among allogenic HSCT patients in a follow up of 1 year.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Acute Kidney Injury ; Haematopoetic ; Stem Cell Transplantation.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 07:44
Last Modified: 11 Jul 2017 07:44

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