Acute kidney injury adversely affects the clinical course of acute myeloid leukemia patients undergoing induction chemotherapy

Olivier Ballo,Uta Brunnberg,Fagr Eladly,Fabian Finkelmeier,Jan Alexander Stratmann,Christian H Brandts,Björn Steffen,Sarah Rudolf,Sebastian Wagner,Stefan Büttner,Eva-Maria Kreisel,Hubert Serve

doi:10.1007/s00277-021-04482-3

Abstract

Acute kidney injury (AKI) complicates the clinical course of hospitalized patients by increasing need for intensive care treatment and mortality. There is only little data about its impact on AML patients undergoing intensive induction chemotherapy. In this study, we analyzed the incidence as well as risk factors for AKI development and its impact on the clinical course of AML patients undergoing induction chemotherapy. We retrospectively analyzed data from 401 AML patients undergoing induction chemotherapy between 2007 and 2019. AKI was defined and stratified according to KIDGO criteria by referring to a defined baseline serum creatinine measured on day 1 of induction chemotherapy. Seventy-two of 401 (18%) AML patients suffered from AKI during induction chemotherapy. AML patients with AKI had more days with fever (7 vs. 5, p = 0.028) and were more often treated on intensive care unit (45.8% vs. 10.6%, p < 0.001). AML patients with AKI had a significantly lower complete remission rate after induction chemotherapy and, with 402 days, a significantly shorter median overall survival (OS) (median OS for AML patients without AKI not reached). In this study, we demonstrate that the KIDGO classification allows mortality risk stratification for AML patients undergoing induction chemotherapy. Relatively mild AKI episodes have impact on the clinical course of these patients and can lead to chronic impairment of kidney function. Therefore, we recommend incorporating risk factors for AKI in decision-making considering nutrition, fluid management, as well as the choice of potentially nephrotoxic medication in order to decrease the incidence of AKI.

Highlights

Acute myeloid leukemia (AML) is a hematological malignancy arising from a clonal proliferation of myeloid precursors losing their ability to differentiate into mature functional blood cells
Four hundred one patients diagnosed with AML between 2007 and 2019 that underwent intensive induction therapy were included in this retrospective analysis
According to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, 72 (18%) AML patients suffered from Acute kidney injury (AKI) during the hospital stay of induction chemotherapy and were assigned to the AML cohort with AKI, and 329 (82%) AML patients did not suffer from AKI during induction chemotherapy and were assigned to the AML cohort without AKI

Summary

Introduction

Acute myeloid leukemia (AML) is a hematological malignancy arising from a clonal proliferation of myeloid precursors losing their ability to differentiate into mature functional blood cells. A curative therapy approach can only be achieved by intensive induction chemotherapy. AML patients undergoing induction chemotherapy are at high risk to develop complications and treatment-related mortality (TRM) remains at a level of 8–15% [3, 4]. Acute kidney injury (AKI) is defined by a rapid and partly reversible restriction of kidney function causing a reduction of renal glomerular filtration rate (GFR) [5]. AKI has been shown to be associated with increased mortality and a higher rate of treatment on intensive care units (ICU) in hospitalized

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