In a retrospective analysis, acute kidney injury (AKI) was identified in 18% of patients with acute myeloid leukemia (AML) being treated with induction chemotherapy, and AKI was associated with worse outcomes. Results of this analysis were published in the Annals of Hematology.
In this single-center study based in Germany, adult patients received induction chemotherapy for AML. Patients with AKI were identified based on criteria recommended in the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline. AKI in these patients was defined by a serum creatinine increase of ≥0.3 mg/dL within the first 48 hours or an increase to ≥1.5 times the baseline value during the 7 days prior to induction. Those with baseline serum creatinine ≥1.5 mg/dL were excluded from analysis. Patients with AKI were stratified for analyses of outcomes based on serum creatinine concentration, and various risk factors additionally were evaluated.
A total of 401 patients with AML were evaluated, with 18% demonstrating AKI. Of patients with AKI, 43.1% had AKI of KDIGO stage 1, 41.7% had KDIGO stage 2 AKI, and 15.3% had KDIGO stage 3 AKI.
Patients who had AKI were more likely to receive treatment in an intensive care unit (45.8%) than were patients without AKI (10.6%; P <.001). AKI was also linked to having more days with fever (7 days vs 5 days; P =.028).
The median overall survival (OS) time was not reached for patients without AKI, while it was 402 days with AKI. By AKI stage, median OS was not reached with stage 1, and it was 366 days with stage 2 and 220 days with stage 3. Rates of overall mortality were 62.5% in patients with AKI and 39.5% in patients without AKI (P =.001). Following induction chemotherapy, complete remission also occurred less often in patients with AKI (54.2%) than in patients without AKI (77.2%; P =.005).
In a multivariate analysis, independent risk factors for AKI appeared to be treatment in an intensive care unit (odds ratio [OR], 7.885 [95% CI, 4.250-14.628]; P <.001), treatment with angiotensin-converting enzyme inhibitors (OR, 2.931 [95% CI, 1.574-5.457]; P =.001), or receipt of liposomal amphotericin B (OR, 2.186 [95% CI, 1.055-4.529]; P =.035).
Several parameters appeared to be independent risk factors related to OS in patients with AML in a multivariate analysis, and AKI during induction was among these (OR, 1.761 [95% CI, 1.184-2.619]; P =.005). Additionally, AKI of stage 1 or 2 during induction, with stage 3 excluded, was an independent risk factor (OR, 1.606 [95% CI, 1.051-2.456]; P =.029).
The researchers found KDIGO classification for AKI to show high prognostic value. They recommended improved awareness of AKI, identification of patients at risk for AKI, and possible early involvement of a nephrologist for high-risk patients.
Ballo O, Eladly F, Büttner S, et al. Acute kidney injury adversely affects the clinical course of acute myeloid leukemia patients undergoing induction chemotherapy. Ann Hematol. Published online March 11, 2021. doi:10.1007/s00277-021-04482-3