Acute renal failure after myeloablative allogeneic hematopoietic stem cell transplantation: incidence, risk factors, and relationship with the quantity of transplanted cells

Figures & data

TABLE 1.  Classification of ARF

Stage
I	Increased serum creatinine × 2 or GFR^a decrease > 50%
II	Increased serum creatinine × 3 or GFR decrease > 75% or serum creatinine > 4 mg/dL
III	Stage II and requiring dialysis

Note: ARF, acute renal failure.

^aGFR determined by estimating creatinine clearance from 24-hour urine collections.

TABLE 2.  Baseline characteristics of the allogeneic HSCT patients (n = 39)

Characteristics	Values
Age (year)	30.97 ± 12.33
Male/female, n (%)	24 (61.5)/15 (38.5)
Diagnosis, n (%)
Acute myeloid leukemia	27 (69.2)
Acute lymphoblastic leukemia	7 (17.9)
Non-Hodgkin's lymphoma	3 (7.7)
Myelofibrosis	1 (2.6)
Myelodysplastic syndrome	1 (2.6)
Hemoglobin level (g/dL)^a	11.06 ± 2.81
White blood cell count (mm^3)^a	4317 ± 2548
Platelet count (mm^3)^a	153769 ± 91285
CD34^+ cell count (×10^6/kg)^a	6.54 ± 1.72
Serum creatinine level (mg/dL)^a	0.71 ± 0.19
Creatinine clearance (mL/min/1.73 m^2)^a	133.03 ± 44.54
Serum albumin level (g/dL)^a	3.72 ± 0.38
24-Hour urine volume (mL/day)^a	2311 ± 1122
Amount of proteinuria (mg/day)^a	224 ± 148

Note: HSCT, hematopoietic stem cell transplantation.

^aData expressed as mean ± SD.

TABLE 3.  Demographic, clinical, and biochemical parameters in patients with and without ARF

Characteristics	ARF group, n = 20	Control group, n = 19	p-Value
Age (year)	32.95 ± 9.62	28.89 ± 14.46	0.307
Gender, n (%)			0.550
Male	12 (60.0)	12 (63.2)
Female	8 (40.0)	7 (36.8)
Body surface area (m^2)	1.73 ± 0.15	1.62 ± 0.15	0.046
Engraftment period (day)	15 (12–23)	14 (11–28)	0.525
Presence of
GVDH, n (%)	2 (10)	4 (21.1)	0.330
Sepsis, n (%)	2 (10)	3 (15.8)	0.475
CD34^+ cell count (×10^6/kg)^a	6.97 ± 1.54	6.10 ± 1.82	0.116
Serum creatinine level (mg/dL)^a
Baseline	0.71 ± 0.18	0.72 ± 0.22	0.865
First week	0.70 ± 0.41	0.56 ± 0.15	0.166
Second week	0.86 ± 0.42	0.61 ± 0.16	0.022
Third week	1.35 ± 0.73	0.73 ± 0.17	0.003
First month	1.62 ± 0.65	0.87 ± 0.22	0.001
Second month	1.46 ± 0.70	0.80 ± 0.22	0.001
Third month	0.94 ± 0.38	0.78 ± 0.17	0.129
Creatinine clearance (mL/min/1.73 m^2)^a
Baseline	141.32 ± 42.80	124.30 ± 45.80	0.238
First week	121.65 ± 59.09	138.10 ± 49.29	0.448
Second week	113.25 ± 67.80	107.74 ± 42.41	0.773
Third week	40.86 ± 15.35	118.14 ± 30.82	0.003
First month	71.26 ± 55.27	112.74 ± 35.85	0.027
Second month	66.71 ± 28.74	111.36 ± 41.36	0.003
Third month	95.92 ± 30.77	117.66 ± 38.98	0.109
Basal hemoglobin level (g/dL)^a	12.21 ± 2.58	9.85 ± 2.58	0.007
Basal WBC count (mm^3)^a	4858 ± 2866	3747 ± 2091	0.177
Basal platelet count (mm^3)^a	153350 ± 63884	154210 ± 115253	0.977
Basal albumin level (g/dL)^a	3.76 ± 0.32	3.67 ± 0.43	0.463
Basal amount of proteinuria (mg/day)^a	209 ± 158	241 ± 139	0.503
Blood cyclosporine level^b	62.50 (20.0–2235.0)	93.7 (50.0–549.0)	0.270

Notes: ARF, acute renal failure; GVHD, graft-versus-host disease; WBC, white blood cell.

^aData given as mean ± SD.

^bData given as median values.

*p < 0.05.

FIGURE 1. Trends of serum creatinine levels and creatinine clearance after myeloblative HSCT. *p < 0.05 when compared to baseline values. 254 × 190 mm (96 × 96 DPI).

TABLE 4.  Demographic, clinical, and biochemical parameters in patients with stage I or stage II ARF

Characteristics	Stage I ARF, n = 11	Stage II ARF, n = 9	p-Value
Age (year)	32.82 ± 10.98	33.11 ± 8.31	0.948
Gender, n (%)			0.535
Male	7 (63.6)	5 (55.6)
Female	4 (36.4)	4 (44.4)
Response after allogeneic HSCT, n (%)			0.030
Remission	5 (45.5)	9 (100)
Partial remission	4 (36.4)	–
No remission	2 (18.2)	–
Presence of
GVDH, n (%)	2 (18.2)	–	0.322
Sepsis, n (%)	–	2 (22.2)	0.189
CD34^+ cell count (×10^6/kg)^a	7.00 ± 1.70	6.93 ± 1.42	0.929
Engraftment period (day)^b	15 (14–23)	14 (12–16)	0.272
Serum creatinine level (mg/dL)^a
Baseline	0.75 ± 0.20	0.65 ± 0.13	0.232
First week	0.63 ± 0.16	0.78 ± 0.59	0.424
Second week	0.79 ± 0.37	0.95 ± 0.48	0.404
Third week	1.19 ± 0.40	1.55 ± 1.01	0.371
First month	1.48 ± 0.53	1.81 ± 0.78	0.290
Second month	1.25 ± 0.41	1.73 ± 0.91	0.195
Third month	1.07 ± 0.45	0.78 ± 0.20	0.125
Creatinine clearance (mL/min/1.73 m^2)^a
Baseline	137.18 ± 49.74	146.38 ± 34.71	0.645
First week	138.41 ± 61.82	102.09 ± 54.23	0.288
Second week	136.10 ± 76.38	80.61 ± 37.35	0.097
Third week	53.37 ± 8.15	28.35 ± 8.54	0.001
First month	79.58 ± 29.63	62.94 ± 35.35	0.626
Second month	84.96 ± 24.45	51.06 ± 23.15	0.026
Third month	100.66 ± 18.24	89.59 ± 43.72	0.527
Duration of ARF^a	31.00 ± 11.85	26.00 ± 16.04	0.473
Hemoglobin level (g/dL)^a
Baseline	12.95 ± 2.90	11.31 ± 1.90	0.163
Second week	9.92 ± 2.42	7.84 ± 1.66	0.043
Third month	9.58 ± 1.72	11.62 ± 1.49	0.018
Basal WBC count (mm^3)^a	5859 ± 3183	3635 ± 1945	0.084
Basal platelet count (mm^3)^a	165090 ± 60079	139000 ± 68992	0.378
Basal albumin level (g/dL)^a	3.80 ± 0.33	3.72 ± 0.33	0.613
Basal amount of proteinuria (mg/day)^a	205 ± 149	213 ± 177	0.916
Cyclosporine level^b
Baseline	65 (20–2235)	60 (40–207)	0.918
Third week	292 (182–951)	763 (500–986)	0.019

Notes: ARF, acute renal failure; HSCT, hematopoietic stem cell transplantation; GVHD, graft-versus-host disease; WBC, white blood cell.

^aData given as mean ± SD.

^bData given as median values.

*p < 0.05.