Acute Kidney Injury in Lymphoma: A Single Centre Experience

Background. Acute kidney injury (AKI) is a common but least studied complication of lymphoma.Objective. To determine the frequency and predictors of AKI in lymphoma and to study the impact of AKI on hospital stay and mortality.Methods. Retrospective review of medical records of hospitalized lymphoma patients aged ≥14 years between January 2008 and December 2011 was done.Results. Out of 365 patients, AKI was present in 31.8% (116/365). Multivariate logistic regression analysis showed that independent predictors for AKI included sepsis (odds ratio (OR) 3.76; 95% CI 1.83–7.72), aminoglycosides (OR 4.75; 95% CI 1.15–19.52), diuretics (OR 2.96; 95% CI 1.31–6.69), tumor lysis syndrome (OR 3.85; 95% CI 1.54–9.59), and R-CVP regimen (OR 4.70; 95% CI 1.20–18.36). AKI stages 2 and 3 was associated with increased hospital stay (OR 2.01; 95% CI 1.19–3.40).Conclusion. AKI was significantly associated with sepsis, aminoglycoside, diuretics, presence of tumor lysis syndrome, and use of R-CVP regimen. Presence of AKIN (Acute Kidney Injury Network) stages 2 and 3 AKI had increased hospital stay. AKI was also associated with increased mortality.

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295 Acute Kidney Injury from Tumor Lysis Syndrome Associated with Ipilimumab/Nivolumab Therapy

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2020.02.297 ◽

2020 ◽

Vol 75 (4) ◽

pp. 621 ◽

Cited By ~ 1

Keyword(s):

Acute Kidney Injury ◽

Tumor Lysis Syndrome ◽

Kidney Injury ◽

Tumor Lysis

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The Impact of Hemodynamic Transesophageal Echocardiography on Acute Kidney Injury Management and Use of Continuous Renal Replacement Therapy in Trauma

The American Surgeon ◽

10.1177/000313482008600326 ◽

2020 ◽

Vol 86 (3) ◽

pp. 190-194

Author(s):

Alex Sapp ◽

Andrew Drahos ◽

Madison Lashley ◽

Amy Christie ◽

D. Benjamin Christie

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Transesophageal Echocardiography ◽

Replacement Therapy ◽

Hospital Costs ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Trauma Patients ◽

The Impact

Resuscitation of critically ill trauma patients can be precarious, and errors can cause acute kidney injuries. If renal failure develops, continuous renal replacement therapy (CRRT) may be necessary, but adds expense. Hemodynamic transesophageal echocardiography (hTEE) provides objective data to guide resuscitation. We hypothesized that hTEE use improved acute kidney injury (AKI) management, reserved CRRT use for more severe AKIs, and decreased cost and resource utilization. We retrospectively reviewed 2413 trauma patients admitted to a Level I trauma center's ICU between 2009 and 2015. Twenty-three patients required CRRT before standard hTEE use and 11 required CRRTafter; these are the “CRRT” and “CRRT/hTEE” groups, respectively. The hTEE group comprised 83 patients evaluated with hTEE, with AKI managed without CRRT. We compared the average creatinine, change in creatinine, and Acute Kidney Injury Network (AKIN) of “CRRT” with “CRRT/hTEE” and “hTEE.” We also analyzed several quality measures including ICU length of stay and cost. “CRRT” had a lower AKIN score (1.6) than “CRRT/hTEE” (2.9) ( P = 0.0003). “hTEE” had an AKIN score of 2.1 ( P = 0.0387). “CRRT” also had increased ICU days (25.1) compared with “CRRT/hTEE” (20.2) ( P = 0.014) and “hTEE” (16.8) ( P = 0.003). “CRRT” accrued on average $198,695.81 per patient compared with “CRRT/ hTEE” ($167,534.19) and “hTEE” ($53,929.01). hTEE provides valuable information to tailor resuscitation. At our institution, hTEE utilization reserved CRRT for worse AKIs and decreased hospital costs.

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Spontaneous Tumor Lysis Syndrome Presenting Acute Kidney Injury with Extreme Hyperuricemia and Urinary Stone: A Rare Case of Spontaneous Tumor Lysis Syndrome

Childhood Kidney Diseases ◽

10.3339/jkspn.2017.21.1.31 ◽

2017 ◽

Vol 21 (1) ◽

pp. 31-34

Author(s):

Seong Heon Kim ◽

Eu Jeen Yang ◽

Young Tak Lim ◽

Su Young Kim

Keyword(s):

Acute Kidney Injury ◽

Rare Case ◽

Tumor Lysis Syndrome ◽

Kidney Injury ◽

Urinary Stone ◽

Tumor Lysis ◽

Spontaneous Tumor ◽

Spontaneous Tumor Lysis Syndrome

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The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China

10.21203/rs.3.rs-16071/v1 ◽

2020 ◽

Author(s):

Lishan Tan ◽

Li Chen ◽

Lingyan Li ◽

Jinwei Wang ◽

Xiaoyan Huang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Renal Recovery ◽

Cross Sectional ◽

Patients With Diabetes ◽

The Impact ◽

Physician Diagnosis

Abstract Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.

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Tumor Lysis Syndrome Management in Community Oncology Settings

Blood ◽

10.1182/blood-2019-132266 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5875-5875

Author(s):

Scott Howard

Keyword(s):

Acute Kidney Injury ◽

Tumor Lysis Syndrome ◽

Kidney Injury ◽

Research Network ◽

Newly Diagnosed ◽

Bulky Disease ◽

Tumor Lysis ◽

Lowering Therapy ◽

Community Oncology ◽

The Guardian

Background Tumor lysis syndrome (TLS) can complicate the management of patients with bulky chemosensitive cancers. TLS incidence and severity are increasing with new highly effective agents for hematologic cancers. However, prophylaxis and management vary widely, even within the same center. Methods We examined TLS management and outcomes from records of 14383 newly-diagnosed adults with lymphoma treated from 2010- 2019 at 110 member hospitals of the Guardian Research Network (GRN, www.GuardianResearch.org), a non-profit community oncology consortium with a database containing patients' entire medical, including all demographics, diagnoses, labs, medications, procedures, encounters, and notes of all kinds (clinical, radiology reports). Anonymized, de-identified data about demographics, diagnosis, treatment, supportive care, and outcomes was analyzed to determine patterns of TLS management in the community setting. Natural language processing was used to identify clinicians' references to tumor lysis syndrome, risk assessment, and cancer bulk. Results Of 529784 cancer patients in the Guardian Research Network database, there were 14383 newly-diagnosed adults with lymphoma, of whom 81% received no uric acid lowering therapy, 17% received allopurinol or febuxostat, and only 2% received Rasburicase. TLS management varied by region: 11% of patients in Virginia received uric acid lowering therapy vs 26% in South Carolina (p<0.001) and lymphoma subtype: 11% Hodgkin lymphoma, 26% B-cell non-Hodgkin lymphomas, p<0.001). Acute kidney injury (AKI) occurred in 4.3% of patients and logistic regression confirmed NHL (versus Hodgkin), black race (versus white), and older age as risk factors (p<0.01 for each). 216 patients (1.5%) died within 30 days. Of special note, bone marrow infiltration in acute leukemia patients was not noted as a site of bulky disease, despite the fact that a marrow with 50% infiltration of leukemic cells typically contains 700 grams of cancer, and represents bulky disease that places the patient at significant risk for TLS if treated with highly active agents. Conclusions Early acute kidney injury is common in patients with B-cell lymphomas. Assessment of TLS risk and prophylaxis is warranted, especially when using new, highly effective chemotherapy agents in patients with bulky disease. Assessment of tumor bulk was rarely documented in the medical records. Table Disclosures Howard: BTG: Consultancy, Research Funding; EUSA Pharma: Consultancy; Sanofi: Consultancy, Speakers Bureau; Servier: Consultancy, Speakers Bureau; Amgen: Honoraria.

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1151: Safety and Efficacy of Renal Replacement Therapy for Acute Kidney Injury in Tumor Lysis Syndrome

Critical Care Medicine ◽

10.1097/01.ccm.0000730492.01892.2f ◽

2020 ◽

Vol 49 (1) ◽

pp. 577-577

Author(s):

Sidra Ishaque ◽

Anwar Haque ◽

Abdul Rahim Ahmed ◽

Farhana Amanullah ◽

Faiza Rehman ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Tumor Lysis Syndrome ◽

Kidney Injury ◽

Safety And Efficacy ◽

Tumor Lysis

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Acute kidney injury associated with tumor lysis syndrome: a paradigm shift

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2010.12.029 ◽

2012 ◽

Vol 30 (2) ◽

pp. 390.e3-390.e6 ◽

Cited By ~ 6

Author(s):

Amr El-Husseini ◽

Alberto Sabucedo ◽

Jorge Lamarche ◽

Craig Courville ◽

Alfredo Peguero

Keyword(s):

Acute Kidney Injury ◽

Paradigm Shift ◽

Tumor Lysis Syndrome ◽

Kidney Injury ◽

Tumor Lysis

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P0568INCIDENCE AND RISK FACTORS OF ACUTE KIDNEY INJURY AND TUMOR LYSIS SYNDROME IN PATIENTS WITH MULTIPLE MYELOMA TREATED WITH BORTEZOMIB

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0568 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

SEUNGMIN SONG ◽

Hyo jin Boo ◽

Hye Ryoun Jang ◽

Wooseong Huh ◽

Dae Joong Kim ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Acute Kidney Injury ◽

High Risk ◽

Multivariate Analyses ◽

Tumor Lysis Syndrome ◽

Kidney Injury ◽

Renal Amyloidosis ◽

Tumor Lysis ◽

Β2 Microglobulin

Abstract Background and Aims Nephrotoxicity of bortezomib, a proteasome inhibitor, has not yet been described frequently, while tumor lysis syndrome (TLS) associated with multiple myeloma (MM) has been increased after introduction of the drug. This study compared the incidence and risk factors of acute kidney injury (AKI) and TLS in patients with MM after bortezomib-based chemotherapy to investigate the drug-related nephrotoxicity. Method From 2006 to 2017, 276 patients who underwent first cycle of bortezomib-based chemotherapy for MM were identified in single tertiary hospital. Laboratory TLS was defined according to the Cairo-Bishop definition. Development of AKI was assessed by AKI Network (AKIN) criteria within 7 days after first chemotherapy. Results The age was 65 [56-72] years old, and 47% (n=131) of participants were female and baseline estimated glomerular filtration rate (eGFR) was 61.3 [34.1-89.1] mL/min/1.73m2. The incidences of AKI and laboratory TLS were 17% (n=47) and 13% (n=36), respectively. Ten (3.6%) subjects corresponded to the both AKI and TLS criteria. Multivariate analyses showed that lower eGFR category (30∼59, odds ratio [OR]=3.063 [1.278-7.339]; 15∼29, OR=3.417 [1.088-10.726]; <15, OR=10.080 [2.677-37.951] vs ≥ 60), lower serum albumin level (OR=0.491 [0.278-0.868], P=0.0144) and renal amyloidosis (OR=11.174 [3.974-31.420], P<0.0001) were predictors of development of AKI. MM stages and β2-microglobulin were not associated with AKI occurrence. Regarding laboratory TLS, MM stage and β2-microglobulin were higher in those with TLS. In multivariate analyses, β2-microglobulin levels (OR=1.194 [1.066-1.337], P=0.0021) and any chromosomes abnormalities at high risk (OR=0.115 [0.026-0.503], P=0.0041) were associated with higher risk of TLS. Conclusion Development of AKI was often observed without being accompanied by TLS in patients with MM after treatment of bortezomib. In addition, risk factors of AKI and TLS were widely different. These findings implicated the potential nephrotoxicity of bortezomib besides TLS in patients with decreased kidney function. The efforts to prevent bortezomib associated AKI are needed in patients at high risk.

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