Acute kidney injury in multiple myeloma patients undergoing autologous hematopoietic stem cell transplant: a cohort study

• Published in: Journal of nephrology Vol. 37; no. 2; pp. 419 - 428
• Main Authors: Rodrigues, Natacha, Costa, Claudia, Branco, Carolina, Martins, Carlos, Lopes, José António
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-03-2024
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Adult; Aged; Female; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Incidence; Male; Medicine; Medicine & Public Health; Middle Aged; Multiple Myeloma - complications; Multiple Myeloma - therapy; Nephrology; original; original Article; Retrospective Studies; Risk Factors; Time Factors; Transplantation, Autologous; Urology; Autologous hematopoietic stem cell transplant; Epidemiology; Acute kidney injury; Multiple myeloma
• ISSN: 1724-6059; 1121-8428; 1724-6059
• DOI: 10.1007/s40620-023-01809-3

Background
Autologous hematopoietic stem cell transplant plays an important role in multiple myeloma (MM) treatment. Increasing incidence of MM and growing awareness of acute kidney injury (AKI) as a complication of hematopoietic stem cell transplant results in the need to better understand AKI in these patients. We aimed to evaluate incidence, risk factors and 5-year prognostic impact of AKI in MM patients undergoing autologous hematopoietic stem cell transplant.
Methods
Retrospective cohort study. AKI was defined by the KDIGO classification using creatinine and urinary output criteria. We used survival analysis methods considering competing events for risk factors and disease-free survival, Cox proportional regression for overall survival and stepwise regression methods for multivariable models.
Results
We analyzed data regarding 143 patients. The cumulative incidence of AKI and moderate-to-severe AKI was 49.7% and 14.1%, respectively. Factors with independent impact on AKI were obesity (HR: 1.83, 95% CI 1.07–3.11;
p
 = 0.026), Hematopoietic cell transplantation—specific comorbidity index (HCT-CI) ≥ 2 (HR: 1.85, 95% CI 1.08–3.17), chronic kidney disease (CKD) (HR: 2.06, 95% CI 1.05–4.04), amyloidosis (HR: 2.25, 95% CI 1.25–4.06), mucositis grade 3–4 (HR: 2.19, 95% CI 1.25–3.86) and exposure to nephrotoxic drugs (HR: 2.0856, 95% CI 1.04–4.19). Moderate-to-severe AKI had an impact (HR: 1.62, 95% CI 1.15–2.31) on 5-year overall survival.
Conclusion
Acute kidney injury affects almost half of MM patients undergoing autologous hematopoietic stem cell transplantation, and reduction in urinary output allows early diagnosis in almost a quarter of the patients. Obesity, HCT-CI ≥ 2, CKD, amyloidosis, mucositis grade 3–4 and exposure to nephrotoxic drugs are significant risk factors. Moderate-to-severe AKI is associated with lower 5-year overall survival.
Graphical abstract