Cumulative Incidence Of Acute Kidney Injury Research Articles

Early acute kidney injury after tacrolimus administration in heart transplant recipients receiving basiliximab induction therapy.

In this study, we aimed to analyze the association among the timing of tacrolimus initiation, time required to reach the target blood concentration, and early acute kidney injury (AKI) after tacrolimus administration in heart transplant recipients who received basiliximab induction therapy. 88 patients treated with tacrolimus-based immunosuppressive therapy were retrospectively reviewed. Induction therapy was administered to 52 patients. AKI was evaluated within 7 days of tacrolimus administration. The rate of increase in tacrolimus trough concentration to the target trough concentration of 10 µg/mL early after its administration was set to be similar in the basiliximab induction and non-induction group; 8 and 2 patients developed AKI in the induction and non-induction group, respectively. In the induction group, there was no significant difference in the timing of tacrolimus initiation and the time required to reach the target concentration between patients who developed and did not develop AKI. In contrast, the cumulative incidence of AKI was significantly different between patients with an estimated glomerular filtration rate below and those with an estimated glomerular filtration rate above 43 mL/min/1.73m2 at the start of tacrolimus administration (37.5% and 11.4%, respectively; p=0.045). In patients receiving basiliximab induction therapy, the timing of tacrolimus initiation and the time to reach the target concentration are unlikely to be associated with early AKI after tacrolimus administration. However, the recovery of sufficient renal function after heart transplantation is important for determining the start time of tacrolimus.

Acute kidney injury in Staphylococcus aureus bacteraemia: a recurrent events analysis

ObjectivesTo estimate risk factors for acute kidney injury (AKI) and the effect of AKI on mortality in Staphylococcus aureus bacteraemia, while taking into account recurrent AKI episodes, competing risks, time-varying variables, and time-varying effects. MethodsWe performed an unplanned analysis using data from a multicentre cohort study of patients with Staphylococcus aureus bacteraemia (SAB). The primary outcome was cumulative incidence of AKI, according to Kidney Disease Improving Global Outcomes definitions. ResultsWe included 453 patients in this study of whom 194 (43%) patients experienced one or more AKI episodes. Age (hazard ratio (HR) 1.013, 95% CI 1.001–1.024), Charlson comorbidity index (HR 1.07, 95% CI 1.01–1.14), prior chronic kidney disease (HR 1.76, 95% CI 1.28–2.42), septic shock (HR 3.28, 95% CI 2.31–4.66), persistent bacteraemia (HR 1.53, 95% CI 1.08–2.17), and vancomycin therapy (HR 1.80, 95% CI 1.05–3.09) were independently associated with AKI, but flucloxacillin, cefazolin, rifampicin, and aminoglycoside therapy were not. After adjustment for confounders and immortal time bias, AKI was associated with an increased risk of 90-day mortality (HR 4.26, 95% CI 2.91–6.23). DiscussionThe incidence of AKI in SAB is high and a substantial proportion of patients develop recurrent episodes of AKI after recovery. AKI is specifically linked to the use of vancomycin and not to anti-staphylococcal penicillins. The clinical outcome of patients with SAB complicated by AKI is worse than previously estimated.

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

BackgroundAutologous 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.MethodsRetrospective 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.ResultsWe 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.ConclusionAcute 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

Impact of Antimicrobial Drug-Drug Interactions on Acute Kidney Injury after Allogeneic Hematopoietic Cell Transplantation

Acute kidney injury (AKI) is one of the major complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The use of multiple antimicrobials is one of the major causes of post-transplantation AKI, owing to the potential nephrotoxicity of each agent and of drug-drug interactions (DDIs). No satisfactory reports on DDIs the field of allo-HSCT have been published. We performed a retrospective analysis to compare the incidence of AKI within 100 days post-transplantation. A total of 465 allo-HSCTs in 416 patients were analyzed, and the cumulative incidence of AKI was 40.0%. AKI was associated with significantly reduced overall survival (hazard ratio [HR], 2.66; 95% confidence interval [CI] 1.95 to 3.55; P < .01) and increased transplantation-related mortality (HR, 4.77, 95% CI, 2.90 to 7.88; P < .01). A higher incidence of AKI was significantly associated with the use of ciprofloxacin, cefepime, tazobactam/piperacillin, meropenem, vancomycin, liposomal amphotericin B, ganciclovir, and foscarnet. Among these drugs, combinations of vancomycin plus tazobactam/piperacillin (HR, 2.23; P=.09 for interaction), ganciclovir plus cefepime (HR, 5.93; P=.04), and ganciclovir plus meropenem (HR, 2.63; P=.12) synergistically increased the risk of AKI, whereas combinations involving teicoplanin did not. This is the first report dealing with DDIs after allo-HSCT, indicating that such combinations should be avoided to preserve renal function and reduce AKI-related morbidity and mortality.

#6652 ACUTE KIDNEY INJURY IN PATIENTS WITH MULTIPLE MYELOMA SUBMITTED TO AUTOLOGOUS HEMATOPOIETIC CELL TRANSPLANT: A COHORT ANALYSIS

Abstract Background and Aims The incidence of most haematological neoplasms has been increasing and with them hematopoietic cell transplantation (HCT) as it provides better survival rates to several of these malignancies. There is a wide range of acute kidney injury (AKI) reported incidence in HCT patients, mostly due to the heterogeneity of AKI definitions and study populations that include different underlying illnesses. We aimed to evaluate incidence, severity and risk factors of AKI by KDIGO classification considering creatinine and urinary output (UO) criteria in patients with multiple myeloma (MM) submitted to autologous HCT. Method We conducted a retrospective cohort study including patients with MM submitted to autologous HCT admitted in a tertiary hospital between Jan./2005-Dec./2015 with a 3 year follow-up period. To evaluate AKI cumulative incidence, risk factors and impact on relapse, survival analysis methods considering death as competing were used. Multivariate stepwise analysis using logistic regression was used to evaluate risk factors associated with AKI. Results 143 patients were included [median age was 50.5 (59.2-63.6) years, 61.5% male and 90.9% Caucasian]. 37.1% had hypertension, 12.6% diabetes mellitus and 10.5% chronic kidney disease (CKD) [median overall baseline eGFR 100.4 (89.5-110.8) mL/min/1.73 m2]. Median percentage of plasma cells on bone marrow aspirate was 30 (17-67) %, serum M-protein 3.3 (2.2-6.6) g/dL and serum titre of the affected light chain 3560 (890-7800) mg/dL. 49 patients had cytogenetic abnormalities. 49% of patients had R-ISS stage I at diagnosis. Median number of previous lines of therapy was 1 (1-2) and the median number of cycles 4 (3-4). 34.5% were previously submitted to radiotherapy. At admission, mean haemoglobin was 11.7 (10.8-12.4) g/dL, neutrophils 3375 (2330-4765) /mm3, serum urea 33 (28-44) mg/dL, uric acid 5 (4.1-6) mg/dL, phosphate 3.4 (3-2.9) mg/dL, LDH 333 (297-390) U/L, albumin 3.9 (3.7-4.2) mg/dL and alanine transaminase 18 (14-27) U/L. Fever (77.6%), exposure to nephrotoxins (74.1%), low grade mucositis (55.9%) and sepsis (26.6%) were common during hospital admission. Cumulative incidence of AKI at 100 days was 49.7% (71 patients) with median time to event of 8 (5-13) days. 85.9% of patients had stage 1 AKI at diagnosis, although 16.4% of these (10 patients) degraded to worse stages. On univariable analysis, the predictor variables with impact on AKI were higher age (p=0.057), higher body mass index (BMI) (p=0.048), HCT-comorbidity index ≥2 (p=0.005), lower baseline eGFR (p&amp;lt;0.001), previous CKD (p=0.001), presence of amyloidosis (p=0.078), higher R-ISS (p=0.002), presence of cytogenetic abnormalities (p=0.055), development of sepsis (p=0.016), fever (p=0.044) and higher grade mucositis (p&amp;lt;0.001), exposure to nephrotoxins (p=0.007), higher neutrophils count (p=0.021), serum urea (p&amp;lt;0.001) and LDH (p=0.002) and lower phosphate (p=0.049), and alanine transaminase (p=0.077). Multivariable analysis showed an independent association of AKI with BMI [HR 1.08 (1.03-1.14), p=0.004], CKD [HR 3.00 (1.55-5.78), p=0.001], amyloidosis [HR 2.73 (1.40-5.33), p=0.003], high grade mucositis [HR 2.35 (1.37-4.02), p=0.002], exposure to nephrotoxins [HR 2.20 (1.08-4.47), p=0.029], leukocyte count [HR 1.01 (1.01-1.01), p&amp;lt;0.001] and serum phosphate [HR 0.57 (0.39-0.84), p=0.004] maintained an independent association with AKI. Conclusion Our results show that AKI occurs in almost half of the patients with MM submitted to HCT and reinforce the need for prevention, monitoring and early approach to AKI in these patients particularly in those with higher BMI, CKD, secondary amyloidosis, higher leukocyte count and lower serum phosphate at admission, as well as in those that develop mucositis and are exposed to nephrotoxins. We also believe considering both SCr and UO KDIGO criteria for AKI may have increased the reliability of our data, this being the first study to include both criteria in this population of patients.

Acute Kidney Injury in Human Immunodeficiency Virus, Tuberculosis, and Human Immunodeficiency Virus/Tuberculosis Patients on Treatment and its Association with Host Predicting Factors, in South-West Region of Cameroon

OBJECTIVES: To evaluate the incidence and severity of kidney injury and explore the host factors to predict acute kidney injury (AKI) among tuberculosis (TB), human immunodeficiency virus (HIV), and TB/HIV patients on the treatment in Fako Division of Cameroon. METHODS: A prospective study was carried out from September 2018 to November 2019. Serum creatinine and urea were measured spectrophotometrically. The Chi-square test with cox regression was used to assess the association between the risk factors and AKI. RESULTS: The overall incidence of AKI and renal injury was 21.4%–41.4%, respectively. Stage 1 AKI as well as mild renal injury was more prevailing among the HIV-infected patients; 10.5% versus 31.4%. The highest incidences; 30.0% AKI, and 53.0% renal injury were recorded amongst those with TB/HIV coinfections and HIV mono-infections, respectively. Persons who were ≥40 years and those with low baseline hemoglobin levels were two times and two and half times more likely to develop AKI compared to their counterparts. CONCLUSIONS: The cumulative incidence of AKI in patients on treatment was high. Thus, it is important to evaluate the renal function of patients before treatment within the first 2 weeks of treatment.

Predictive value of lactate dehydrogenase combined with the abbreviated burn severity index for acute kidney injury and mortality in severe burn patients

BackgroundExtensive burns are devastating trauma. This study aimed to explore the predictive value of early lactate dehydrogenase (LDH) level, the abbreviated burn severity index (ABSI) and their combination on acute kidney injury (AKI) and mortality after severe burns. Methods and results194 severe burn patients (TBSA ≥ 30%) were included. After multivariate analyses, early LDH value (first 24 h after admission) was an independent risk factor for early AKI (OR=1.095, CI,1.025–1.169,p = 0.007) and AKI (OR=1.452, CI,1.131–1.864, p = 0.003) in severe burn patients and was still a significant risk factor for mortality (OR=1.059, CI,1.006–1.115，p = 0.03). In ROC analysis, after combining LDH and ABSI, the AUC values were 0.925 for AKI, 0.926 for stage 3 AKI, and 0.904 for mortality. Based on cut-off values, patients were divided into different risk groups. The cumulative incidence of AKI (within 5 days, 30 days) and survival rate (within 60 days) were analyzed by the Kaplan-Meier method. The mortality, AKI incidence, and AKI staging showed a significant upward trend with the increasing risk level (P < 0.001). ConclusionEarly LDH level is an independent risk factor for early AKI and AKI. LDH combined with ABSI can better predict mortality and AKI than single indicators.

Acute Kidney Injury in Patients with Leukaemia Submitted to Allogeneic Hematopoietic Stem Cell Transplant – KDIGO Classification with Creatinine and Urinary Output Criteria: Cohort Analysis

Background: Allogeneic Hematopoietic Stem Cell Transplant (allo-HSCT) is often complicated by Acute Kidney Injury (AKI) and has been increasingly used in patients with leukaemia. Studies on this subject include patients with several haematological diseases and use only Serum Creatinine (SCr) to define AKI. We aimed to evaluate incidence, risk factors and 5-year prognostic impact of AKI in patients with leukaemia submitted to allo-HSCT by SCr and Urinary Output (UO). Methods: We conducted a single-centre retrospective cohort study. AKI was defined according to KDIGO classification. We used survival analysis methods considering competing events - the Fine and Gray method - to identify AKI risk factors and assess the impact of AKI on disease-free survival. Additive Cox proportional hazards regression models were applied to analyse time until death from all causes. Stepwise selection regression methods were used to create the final multivariable model. Results: We included 164 patients. The cumulative incidence of AKI was 63.4% 100 days post-HSCT. On the first day of AKI, 76.9% presented SCr criteria, 15.4% presented UO criteria and 7.7% presented both criteria. The highest stage of AKI was 1 in 61.8%, 2 in 21.6% and 3 in 16.7%. Variables independently associated with AKI: HCT-CI &gt;2 (HR:1.88,95%CI:1.13- 3.11;p=0.015), radiotherapy in the past (HR:2.07,95%CI:2.07- 1.06;p=0.034), LDH at hospital admission (HR:1.51,95%CI:1.03- 2.21;p=0.035), shock (HR:1.57,95%CI:1.02-2.39;p=0.039), and sepsis (HR:3.36,95%CI:1.22-9.24;p=0.019). Severe AKI was independently associated with lower overall survival along the first 5 years (HR:1.76,95%CI:1.03-3.00;p=0.037). Conclusion: AKI in leukaemia patients submitted to allo-HSCT had a cumulative incidence of 63.4% and more than 15% of these patients presented only with UO reduction on the day of AKI onset. Two thirds of the patients evolved with AKI stage 2 or 3. Sepsis, previous radiotherapy treatments at any time before HSCT, HCT-CI scoring higher than 2 points, shock and higher LDH levels increased the risk of developing AKI. Severe AKI was associated to lower overall survival throughout the first five years after allo-HSCT. To our knowledge, this is the first study considering both SCr and UO for AKI patients with Leukaemia submitted to allogeneic Hematopoietic Stem Cell Transplant.

MO311: Acute Kidney Injury in Leukaemia Patients Submitted to Allogeneic Haematopoietic Stem Cell Transplant—Incidence and Risk Factors: A Cohort Analysis

Abstract BACKGROUND Studies on acute kidney injury (AKI) in hematopoietic stem cell transplant (HSCT) consider several haematologic diagnoses in their cohorts and heterogeneous definitions for AKI not taking into consideration urinary output (UO). We aimed to evaluate the incidence and risk factors of the first AKI episode in patients with leukaemia submitted to allogeneic HSCT occurring in the first 100 days post-HSCT, considering both SCr and UO criteria in KDIGO classification. METHODS We conducted a single-center retrospective cohort study, including patients with leukaemia admitted for allogeneic HSCT between 2005 and 2015. KDIGO classification was used for AKI diagnosis considering daily values of SCr and 6-h UO from admission day for HSCT until hospital discharge, and weekly evaluations within the first 100 days beyond hospital discharge. To estimate AKI cumulative incidence and to establish AKI risk factors, survival analysis methods considering death as a competing risk were used. RESULTS A total of 164 patients, 54.3% female, 91.5% Caucasian, median age 39.1 (P25 = 28.1–P75 = 50.4), body mass index 23.2(20.9–25.3), HCT-CI (haematopoietic cell transplantation-specific comorbidity index) &amp;lt; 2 in 85.4% of patients. Of them, 55.5% had acute myeloid leukaemia, 33.5% had acute lymphoblastic leukaemia, 8.5% had chronic myeloid leukaemia and 2.4% had rare forms of leukaemia. A total of 6.7% had been submitted to radiotherapy in the past, median number of chemotherapy cycles was 3 (2–4). A total of 71.3% were prescribed a reduced-intensity conditioning regimen, 56.1% had a related donor and peripheral blood was the source of progenitor cells in 13.4%. In the 100 days post-HSCT, 89.6% developed sepsis, 82.9% were exposed to nephrotoxic drugs, 39.0% had hypovolemia, 25.0% complicated with shock and 7.9% went to intensive care unit. A total of 71.3% developed graft versus host disease, 32.3% registered cytomegalovirus infection. The cumulative incidence of AKI was 58.5% at 30 days post-HSCT and 63.4% at 100 days post-HSCT. AKI diagnosis was first made by SCr criteria in 76.9%, by UO criteria in 15.4% and by both in 7.7%. The highest stage of AKI was 1 in 61.8%, 2 in 21.6% and 3 in 16.7%. A total of 12.5% underwent renal replacement therapy. In our multivariable model, variables independently associated with a higher incidence of AKI were: HCT-CI &amp;lt; 2 [HR 1.88, 95% confidence interval (95% CI) 1.13–3.11; P = .015], previous radiotherapy (HR 2.07, 95% CI 1.06–4.03; P = .034), shock (HR 1.57, 95% CI 1.02–2.39; P = .039), LDH (HR 1.51, 95% CI 1.03–2.21; P = .035) and sepsis (HR 3.36, 95% CI 1.22–9.24; P = .019). CONCLUSIONS AKI incidence affects almost two-thirds of patients with acute and chronic leukaemia submitted to allogeneic HSCT. More than 25% of AKI patients reach stages 2–3. HCT-CI, previous radiotherapy, shock, LDH and sepsis are important independent AKI risk factors. This should bring the attention to the need of developing prevention strategies towards these aspects. This is the first study considering both SCr and UO for defining AKI by KDIGO classification in HSCT, as well as focusing specifically on patients with leukaemia. This approach contributes for a more accurate evaluation and bias reduction.

The Impact of Anti-Microbial Drug-Drug Interactions on Acute Kidney Injury after Allogeneic Hematopoietic Cell Transplantation

Introduction: Acute kidney injury (AKI) is one of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT), and several studies have demonstrated a relationship between poor outcome and the concomitant AKI in the early phase after allo-HCT. Among various post-transplant factors, usage of antimicrobial agents, especially in cases where multiple agents are combined, may be one of the major causes of post-transplant AKI, due the potential nephrotoxicity of each agent and drug-drug interactions. An association between the combination of vancomycin (VCM) with piperacillin/tazobactam (PIPC/TAZ) and increased risk of developing AKI after allo-HCT has been reported; however, no reports have demonstrated the impact of other combinations on post-transplant AKI. Herein, we performed a retrospective analysis to compare the incidence of AKI according to selected antimicrobial agents, using a database with information covering the time-dependent administrative status of all the agents involved. Methods: We included patients with hematological malignancies who received allo-HCT between 2006 and 2018 in Kyoto University, Kyoto, Japan to evaluate the incidence and risk factors of AKI early after transplantation (before Day100). The incidence of AKI was defined according to Acute Kidney Injury Network (AKIN) classification and evaluated, considering early death as a competing risk. Administrative status of each antimicrobial agent was treated as a time-dependent covariate, and the synergetic effects on AKI by multiple agents in combination were evaluated as p for interaction. Results: In total, 465 transplant cases (416 patients) were included. The median age at HCT was 49 years old (range, 17-70). Among these, 104 cases received a related-donor transplant (64 patients received bone marrow and 40 peripheral-blood stem cell grafts), 207 received a transplant from unrelated donors, and 154 received a single-unit cord-blood transplant. The median value for pre-transplant serum creatinine (sCr) was 0.6 (range, 0.20-1.68). The cumulative incidence of AKI at Day100 was 40.0%, and overall survival (OS) at 3 years after HCT was 43.5% in patients with AKI while 70.9% in those without AKI (hazard ratio [HR] = 2.63, 95% confidence interval = 1.95-3.55, p &amp;lt; 0.01). Being male and having a higher pre-transplant sCr were significant risk factors for AKI (HR = 1.53, p &amp;lt; 0.01 and HR = 4.21, p &amp;lt; 0.01, respectively). After HCT, 34 types of oral or intravenous antimicrobial agents (17 antibiotics, 6 antivirals, and 11 antifungals) were utilized across the entire cohort. A higher incidence of AKI was significantly associated with the use of intravenous ciprofloxacin, foscarnet (FCN), ganciclovir (GCV), liposomal amphotericin B (L-AMB), meropenem (MEPM), PIPC/TAZ, and VCM (p &amp;lt; 0.05). Next, we investigated the synergistic impacts of using anti-pseudomonal antibiotics and anti-methicillin resistant staphylococcus aureus (MRSA) agents, because empiric treatment of febrile neutropenia after HCT often relies on this combination, i.e. CFPM, PIPC/TAZ, or MEPM in combination with VCM or teicoplanin (TEIC). As a result, sole administration of VCM was associated with a higher incidence of AKI; this effect was enhanced when VCM was used in combination with PIPC/TAZ (HR = 3.03, p &amp;lt; 0.01 for VCM without PIPC/TAZ; HR = 4.38, p &amp;lt; 0.01 for VCM with PIPC/TAZ), indicating the existence of interaction between VCM and PIPC/TAZ. However, for the concomitant use of VCM plus CFPM or MEPM, no synergistic interaction was observed with regard to the increased incidence of AKI. In addition, administration of TEIC alone and any combination used with TEIC were not associated with an increased risk of AKI. An increased risk of AKI was also confirmed for the combination of MEPM plus GCV or FCN, and GCV plus L-AMB. Conclusions: AKI was significantly associated with poorer OS, and specific antimicrobial combinations were suggested to increase the risk of AKI. Avoidance of such combinations should be considered to preserve renal function and to reduce AKI-related morbidity and mortality. Disclosures No relevant conflicts of interest to declare.

Is There An Association Between Use Of Androgen Deprivation Therapy And Acute Kidney Injury In Prostate Cancer Patients Treated With Definitive Radiotherapy?

Androgen Deprivation Therapy (ADT) has been demonstrated to improve survival in men with prostate cancer undergoing definitive radiotherapy. However, ADT may have deleterious effects on cardiovascular, metabolic, bone, and mental health. Little is known about possible effects of ADT on renal function. Recent observational studies have demonstrated an association between ADT use and Acute Kidney Injury (AKI). These studies have included heterogeneous populations undergoing a variety of treatments, which may predispose to selection bias, and do not reflect recent changes in the definition of AKI. We sought to investigate the incidence of AKI in a large cohort of US veterans receiving definitive radiotherapy +/- ADT for prostate cancer. We investigated the prevalence of AKI through the Veterans Affairs Informatics and Computing Infrastructure (VINCI) platform. Our cohort consists of 44,246 veterans diagnosed with nonmetastatic prostate cancer between January 1st 2001 and October 31st 2015. All were treated with definitive radiotherapy. Exposure was defined as initiation of ADT within one year of diagnosis. The primary outcome was the incidence of AKI, defined via ICD codes. Covariates included in the multivariable regression model were: Age, Charlson Comorbidity Index score, race, smoking status, region, income, education, marital status, and year of diagnosis. Within the study population, 16,275 patients (37%) received RT+ADT and 27,971 (62%) received RT alone. With a median follow up of 6.8 years, there were 3,853 patients diagnosed with an AKI during the study period including 1,753 ADT users (10.8%) and 2,100 non-ADT users (7.5%). The overall cumulative incidence of AKI at 10 years was 11.4% including 14.1% for ADT users and 9.8% for non-ADT users. In the multivariable competing risks model, there was a significant association between ADT and AKI (subdistribution hazard ratio (SHR) = 1.28, 95% CI = 1.20-1.37, p<0.01). The use of ADT was associated with an increased risk of AKI in a large, modern cohort of US veterans undergoing definitive radiotherapy for prostate cancer. These findings warrant prospective confirmation, but suggest that renal function may be an important consideration when assessing the risks and benefits of ADT use. Further study will be useful to investigate if particular subgroups of patients receiving ADT are more susceptible to AKI and if the increased rate of AKI is associated with any long-term effects on renal function.

Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

ObjectiveAgricultural workers worldwide exposed to heat stress could be at the risk of kidney injury, which could lead to chronic kidney disease of an unknown origin (CKDu). Hydration has been promoted as a key measure to reduce kidney injury. In the presence of a hydration intervention, the incidence of acute kidney injury (AKI) was calculated in a sugarcane worker population in Guatemala and several risk factors were evaluated.MethodsWe measured kidney function at the beginning and end of the work shift at three time points in 517 sugarcane workers. We defined AKI as an increase in serum creatinine of 26.5 µmol/L or 50% or more from the pre-shift value. Associations between AKI and risk factors were examined, including interactions with hydration status.ResultsThe prevalence of dehydration post-shift (> 1.020 specific gravity) was 11% in February, 9% in March, and 6% in April. Cumulative incidence of AKI was 53% in February, 54% in March, and 51% in April. AKI was associated with increasing post-shift specific gravity, a dehydration marker, (OR 1.24, 95% CI 1.02–1.52) and with lower electrolyte solution intake (OR 0.94, 95% CI 0.89–0.99).ConclusionsDehydration and insufficient electrolyte consumption are risk factors for AKI. However even well-hydrated sugarcane workers routinely experience AKI. While hydration is important and protective, there is a need to understand other contributors to risk of AKI and identify prevention strategies with these workers.

107 A SINGLE CENTRE INCIDENCE, RISK FACTORS AND SHORT TERM OUTCOMES OF ACUTE KIDNEY INJURY IN ADULTS AT HOSPITAL SULTANAH NUR ZAHIRAH

Category: Epidemiology and Outcomes from AKI Presenter: Dr NURUL AIN YUSOF Keywords: Acute Kidney Injury, Incidence, Risk Factors, Outcomes The epidemiology of Acute Kidney Injury (AKI) in developing country is under reported. The rate of AKI has increased with high mortality. Age, evidence of chronic kidney disease, sepsis, multiple comorbidities (Diabetes Mellitus, Hypertension, Ischeamic Heart Disease) and multi organ dysfunction at the initial presentation were among risk factors for AKI. To determine single centre incidence, risk factors and analysis of association for short term outcomes and risk factors of AKI . This is a retrospective cross sectional cohort analysis of patient diagnosed with AKI admitted to medical and non-medical ward at Hospital Sultanah Nur Zahirah from 1st June 2015 to 31th December 2015. All subjects with abnormal serum creatinine were screened via computerized Hospital Information System(HIS) and recruited in the study based on the inclusion criterias. The demographic criterias, risk factors, management and short term outcomes of AKI were recorded and analyzed using Pearson's Chi square and the association between the outcome and the risk factors were analyzed with multiple logistic regression. A total of 210 patients admitted with AKI in a given study period. The cumulative incidence of AKI in our cohort is 11%. Of these, 30%( 63) were males and 70%( 147) were females and 56% of them (119) were more than 60 years of age. Identified risk factors for AKI are age, cardio renal syndromes, sepsis, drugs related and post-operative period with sepsis and post-operation had significant p value of 0.002 and 0.019. Short term outcomes include renal recovery in 28.5%, 3.8% had surgical intervention, 12.8% required dialysis support and 54.8% patients died (of which 20 requires renal replacement therapy). Main cause of death is septiceamia shock (56%). Sepsis has significant association with outcome i.e mortality and abnormal renal function with p value of 0.001(95% CI: 1.6-4.9) and 0.03 (95%CI: 0.25 -0.93). Renal recovery is significantly associated with gender, cardio-renal syndromes and sepsis with p value of 0.03 (95%CI: 0.21-0.94), 0.01(95% CI: 0.03-0.62) and 0.008 (95% CI: 0.22- 0.80) respectively. AKI cause significant morbidity and mortality for at risks population. This database perhaps would initiate more studies in the area as early recognition would certainly improve AKI outcomes.

Acute kidney injury is a powerful independent predictor of mortality in critically ill patients: a multicenter prospective cohort study from Kinshasa, the Democratic Republic of Congo.

BackgroundDespite the growing incidence of acute kidney injury (AKI) worldwide, there is little data on the burden and outcomes of AKI in intensive care unit (ICU) in low resource settings. The present study assessed the incidence of AKI and its impact on mortality in ICU in Kinshasa (Democratic Republic of Congo).MethodsIn a prospective cohort study, 476 consecutive critically ill patients (mean age 52 years, 57 % male) were screened for the presence of AKI in seven ICU from January 1st to March 30th, 2015. Serum creatinine was measured by the enzymatic method (Cobas C111 device®). AKI and its stages (no AKI, AKI 1, AKI 2 and AKI 3) were defined according to AKIN recommendations. The primary outcome was 28 days mortality. Survival (time-to death) curves were built using the Kaplan Meier methods. Predictors of mortality were assessed by Cox proportional hazards regression models. p < 0.05 defined the level of statistical significance.ResultsThe cumulative incidence of AKI was 52.7 % with AKI stage 1, 2 and 3 in 23.7 %, 16.2 % and 12.8 % of patients, respectively. Among patients who developed AKI, 146 died (58 %) vs 62 patients (28 %) in the group without AKI. Only 6.5 % of the patients with AKI stage 3 benefited from dialysis. Median survival time was 15.0 days in patients without AKI and 3.0 days, 6.0 days and 8.0 days in patients with AKI stage 3, 2 and 1 (p < 0.001), respectively. In addition to respiratory distress-induced polypnea (HRa 1.60; 95 % CI: 1.08–2.37; p = 0.018), oxygen desaturation (HRa 1.53; 95 % CI: 1.13–2.08; p = 0.006) and multi-organic involvement (HRa 1.63; 95 % CI: 1.15–2.30), AKI emerged as an independent predictor of death (HRa 1.82; 95 % CI: 1.34–2.48; p < 0.001).ConclusionMore than half of critically ill patients in the present cohort developed AKI which contributed substantially to short-term mortality, highlighting the need for its prevention, early detection and management as well as the availability of dialysis in ICU.

Cumulative Incidence of Acute Kidney Injury in California's Agricultural Workers.

Chronic kidney disease in Central America suggests that agricultural work is potentially harmful to the kidneys. We investigated the cumulative incidence of acute kidney injury (AKI) over one work shift among agricultural workers in California. Serum creatinine was measured both before and after a work shift to estimate AKI. Associations of incident AKI with traditional and occupational risk factors were tested using Chi-square and trend tests and logistic regression. In 295 agricultural workers, AKI after a summer work shift was detected in 35 participants (11.8%). Piece-rate work was associated with 4.52 adjusted odds of AKI (95% confidence interval 1.61 to 12.70). The cumulative incidence of AKI after a single day of summer agricultural work is alarming due to an increased risk of long-term kidney damage and mortality.

Abstract P3-07-29: Association between adjuvant chemotherapy and risk of acute kidney injury in elderly women diagnosed with early stage breast cancer

Abstract Background: Acute kidney injury (AKI) is a serious complication of cancer and its treatment, causing delay or interruptions in cancer therapy and increased risk of adverse outcomes including premature death. Little is known from large population-based cohort studies about the association between chemotherapy (chemo) and risk of AKI in elderly cancer patients (pts). Methods: This retrospective cohort study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Women diagnosed with stages I-III breast cancer (BC) at ages 66-89 years between 1992-2007 were included. We performed 1-1 sequential matching on time-dependent propensity score on the day of adjuvant chemo initiation within 6 months (mos) after the first surgery. Follow-up (F/U) began on the matching date and ended at AKI occurrence, chronic kidney disease diagnosis, death, change in enrollment status, or 6 mos after the matching date. For pts in the matched untreated cohort, F/U time was also censored at chemo initiation. Chemo was identified in claims through billing codes indicating drugs or administration. Regimens of interest included anthracyclines (A), CMF, taxanes (T, no anthracyclines), and others. AKI was identified in hospital claims. The cumulative incidence of AKI was assessed using the Kaplan-Meier method. The association between adjuvant chemo and risk of AKI was evaluated using a Cox proportional hazards model. The analyses were repeated by regimen type. Results: The matched study cohorts included 28,048 pts. The mean (standard deviation) F/U time was 6.0 (0.8) mos for the chemo cohort and 4.3 (2.5) mos for the matched no-chemo cohort. The cumulative incidence of AKI at mos 1, 3, and 6 was 0.24%, 0.50%, and 0.80% for pts receiving chemo, compared with 0.05%, 0.17%, and 0.30% for no-chemo pts (P&amp;lt;0.001). Adjuvant chemo was associated with a 2.7-fold increased risk of AKI (HR 2.7, 95% CI 1.8-4.1; P&amp;lt;0.001), despite a very low overall incidence rate (16 and 6 per 1000 person-years in chemo and no-chemo pts, respectively). Further examination of distribution of other diseases coded on hospital claims in AKI pts showed that septicemia occurred in 40% of chemo-treated pts with AKI and in only 17% of untreated pts with AKI. Of chemo-treated pts, 53%, 31%, 7%, and 8% received an A-based, a CMF, a T-based, and other regimens, respectively. Each regimen was significantly associated with increased risk of AKI, with the strongest association for a T-based regimen (HR 4.2, 95% CI 2.2-7.8), the weakest for a CMF regimen (HR 2.2, 95% CI, 1.3-3.8), and intermediate associations for an A-based regimen (HR 2.5, 95% CI 1.6-4.1) and others (HR 3.0, 95% CI 1.5-6.2), but the effect of these regimens did not significantly differ from each other. Conclusion: Adjuvant chemo is associated with increased risk of AKI in elderly women diagnosed with early stage BC. This association may be partially explained by septicemia caused by infection/neutropenia due to use of myelosuppressive chemotherapeutic agents, highlighting the importance of preventing serious complications of chemo in preventing AKI. Citation Format: Shuling Li, Jiannong Liu, Beth A Virnig, Allan J Collins. Association between adjuvant chemotherapy and risk of acute kidney injury in elderly women diagnosed with early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-29.

Acute kidney injury after myeloablative cord blood transplantation in adults: the efficacy of strict monitoring of vancomycin serum trough concentrations

Acute kidney injury (AKI) is a common medical complication after myeloablative allogeneic stem cell transplantation (SCT). We have previously performed a retrospective analysis of AKI after cord blood transplantation (CBT) in adults, and found that the maximum of vancomycin (VCM) trough levels were significantly higher in patients with AKI. Following these results, we have monitored VCM serum trough concentrations more strictly, to not exceed 10.0mg/L, since 2008. In this report, we performed an analysis of AKI in a new group of 38 adult patients with hematological malignancies treated with unrelated CBT after myeloablative conditioning between January 2008 and July 2011. Cumulative incidence of AKI at day 100 after CBT was 34% (95% confidence interval 19-50). The median of the maximum value of VCM trough was 8.8 (4.5-12.2) mg/L. In multivariate analysis, no factor was associated with the incidence of AKI. No transplant-related mortality was observed. The probability of disease-free survival at 2years was 83%. These findings suggest that strict monitoring of VCM serum trough concentrations has a beneficial effect on outcomes of CBT.

Pre-Transplant Predictors and Post-Transplant Sequels of Acute Kidney Injury After Allogeneic Stem Cell Transplantation.

AbstractAbstract 4515 Introduction:Acute kidney injury (AKI) is one of the most common complications after allogeneic stem cell transplantation (SCT). Although various post-transplant risk factors for AKI have been reported, there have been few studies which comprehensively assessed pre-transplant comorbidities and investigated their impact on the occurrence of AKI. Methods:We performed a retrospective analysis of 207 consecutive adult patients undergoing myeloablative or non-myeloablative SCT between 2001 and 2009. Cumulative incidence of AKI during the first 100 days was analyzed. AKI was defined and classified according to Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria. Renal dysfunction considered to be associated with multiple organ dysfunction syndromes before death was excluded. The time to the development of severe AKI (defined as RIFLE class I or class F) was calculated and the multivariate analysis of pre- and post-transplant variables was performed by a Cox proportional hazards model. Post-transplant factors were assessed as time-dependent variables. As a representative of pre-transplant comorbidities, we used the hematopoietic cell transplantation-specific comorbidity index (HCT-CI). To analyze the outcomes of patients who developed AKI, the multivariate analysis of OS and NRM was carried out by a landmark approach, in which the follow-up was started at the onset of AKI class R or severe AKI in patients who developed AKI class R or severe AKI, and at the median time of the incidence of AKI in patients who did not develop AKI. Results:Among 207 patients, myeloablative SCT was performed in 149 patients and non-myeloablative SCT in 58 patients. Overall, 158 patients (76.3%) developed AKI, and 92 patients (44.4%) developed severe AKI. The median interval to the occurrence of severe AKI was 30 days after SCT. The cumulative incidence of severe AKI within 100 days in patients with a HCT-CI score 0, 1–2, and ≥3 was 21.3 %, 48.8%, and 73.9%, respectively. In a multivariate analysis, the HCT-CI was independently and most strongly associated with severe AKI (HCT-CI 1–2: adjusted hazard ratio [HR] 2.42, P<0.01; HCT-CI ≥3: adjusted HR 4.69, P<0.01), although no patients had renal dysfunction defined by the HCT-CI scoring system (pre-transplant creatinine > 2.0 mg/dl) before SCT in our cohort. Among post-transplant factors, sepsis (HR 2.66, P<0.01) and use of vancomycin (HR 1.79, P=0.04) were significantly associated with the development of severe AKI. In total, 101 of 207 patients (48.8%) died, of which 52 patients (51.5%) died of non-relapse causes. In a landmark analysis, the 3-year OS was 61.4% in patients without AKI, 53.9% in patients with AKI class R, and 39.3% in patients with severe AKI (P<0.01). The 3-year NRM was 5.6% in patients without AKI, 16.6% in patients with AKI class R, and 40.8% in patients with severe AKI (P<0.01). Multivariate analysis showed that severe AKI was a significant risk factor for worse OS (HR: 2.10, P=0.01) and NRM (HR: 6.15, P<0.01), while the occurrence of AKI class R did not have a strong impact on OS (HR: 1.14, P=0.69) or NRM (HR: 2.31, P=0.20). According to the cause of death, 24 patients died of severe AKI within 100 days after SCT, consisting of 2 on-disease patients (8.3% of the 24 patients who relapsed within 100 days after SCT) and 22 patients in remission (12.0% of the 183 patients who did not relapse within 100 days after SCT). There was no significant difference in the proportions of severe AKI as a mortality cause between patients with or without relapse (P=1.0). Conclusions:We found that high HCT-CI scores, particularly ≥3, were the most important pre-transplant predictor of severe AKI. The development of severe AKI within the first 100 days after SCT was independently associated with worse prognosis, irrespective of the status of the primary disease. Therefore, the strategy to prevent the occurrence of life-threatening severe AKI in patients with a high HCT-CI score would be imperative to improve their survival after allogeneic SCT. Disclosures:No relevant conflicts of interest to declare.

Pretransplant Predictors and Posttransplant Sequels of Acute Kidney Injury after Allogeneic Stem Cell Transplantation

Acute kidney injury (AKI) is a common complication after allogeneic stem cell transplantation (SCT). Although various risk factors for AKI have been reported, the influence of pretransplant comorbidity on the incidence of AKI has not been well investigated. We performed a retrospective analysis of 207 consecutive patients undergoing myeloablative or nonmyeloablative SCT between 2001 and 2009, using the hematopoietic cell transplantation-specific comorbidity index (HCT-CI) as a representative of pretransplant comorbidities. According to Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria, 158 patients (76.3%) developed AKI, and 92 patients (44.4%) developed severe AKI (RIFLE class I or class F) within 100 days after SCT. The cumulative incidence of severe AKI within 100 days in patients with an HCT-CI score 0, 1-2, and ≥3 was 21.3%, 48.8%, and 73.9%, respectively. In multivariate analysis, the HCT-CI was independently associated with severe AKI (HCT-CI 1-2: adjusted hazard ratio [HR] 2.42, P < .01; HCT-CI ≥3: adjusted HR 4.69, P < .01). In a landmark analysis, patients with severe AKI had a lower 3-year overall survival (OS) (39.3% versus 61.4%, P < .01), and a higher 3-year nonrelapse mortality (NRM) (40.8% versus 5.6%, P < .01) than those without AKI. Multivariate analysis showed that severe AKI was a significant risk factor for worse OS (HR: 2.10, P = .01) and NRM (HR: 6.15, P < .01). Thus, it is important to assess the HCT-CI to predict the incidence of AKI, which is a strong indicator of worse prognosis after SCT.

Is Anemia at Hospital Admission Associated with In-Hospital Acute Kidney Injury Occurrence?

Background: The effect of acute kidney injury (AKI) on anemia has been well-documented. However, the effect of ‘preexisting’ anemia on AKI has been less addressed. The aims of the present study were to investigate (1) the association between anemia at hospital admission and AKI occurrence, and (2) the effect of ‘preexisting’ anemia on the clinical outcomes of AKI. Methods: A retrospective cohort study was undertaken among patients aged ≧17 years who were admitted to our hospital during the year 2006 (n = 34,802). Anemia at hospital admission and AKI occurrences were determined using the WHO definition and the RIFLE criteria, respectively. A subgroup of patients with an estimated glomerular filtration rate ≧60 ml/min/1.73 m² was analyzed separately to control for the effect of chronic kidney disease on anemia. Results: The cumulative incidence of AKI was 11.2% in anemic patients at hospital admission, compared to 5.5% in nonanemic subjects. The association between anemia at admission and AKI occurrence remained statistically significant after controlling for potential confounders (odds ratio 1.5, 95% CI 1.4–1.6). In addition, an association between anemia at hospital admission and clinical outcomes of AKI was observed. Conclusion: Anemia at hospital admission should be recognized as a potential risk factor for in-hospital AKI occurrence.