Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Contemporary analysis of the influence of acute kidney injury (AKI) after myeloablative hematopoietic cell transplantation on long-term patient's survival

Bone Marrow Transplantation volume 42, pages 139–141 (2008)Cite this article

Recently, ‘the Acute Dialysis Quality Initiative (ADQI) workgroup,’1 proposed a new classification for acute kidney injury (AKI), ‘RIFLE’ (Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease), which defines AKI as an increase of serum creatinine of at least 50% from baseline or a decrease of glomerular filtration rate greater than 25% or urine output lower than 0.5 ml/kg/min for at least 6 h. It also considers three levels of renal dysfunction (risk, injury and failure) and two outcome classes (loss of kidney function and end-stage kidney disease). RIFLE has been used in multiple studies,2, 3, 4, 5 and it has been shown to be a good tool for the prognostic stratification of the hospitalized patients in general, as well as in the intensive care unit setting. In a previous study, we found that this scoring system predicts mortality in myeloablative autologous and allogeneic hematopoietic cell transplantation (HCT). However, most recently, the Acute Kidney Injury Network (AKIN)6 has proposed a new classification for AKI (Table 1) that differs from RIFLE as follows. It reduces the need for a baseline creatinine value but does require at least two creatinine values within 48 h. AKI is defined as an abrupt (within 48 h) reduction in kidney function currently defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg per 100 ml (⩾26.4 μmol/l), a percentage increase in serum creatinine of more than or equal to 50% (1.5-fold from baseline), or a reduction in urine output (documented oliguria of less than 0.5 ml/kg/h for more than 6 h). ‘Risk’ maps to stage 1, but it also considers an increase in serum creatinine of more than or equal to 0.3 mg per 100 ml (⩾26.4 μmol/l). ‘Injury’ and ‘Failure’ map to stages 2 and 3, respectively. Stage 3 also includes patients who need renal replacement therapy irrespective of the stage they are in at the time of renal replacement therapy, and the two outcome classes ‘Loss’ and ‘End-stage kidney disease’ have been removed. These modifications were introduced to confer a greater sensitivity and specificity to this classification as compared with RIFLE. We have applied the AKIN classification7 in patients who received a myeloablative autologous or allogeneic HCT in our Hospital between January 2003 and December 2004, and have found that in-hospital mortality increased as renal function deteriorated and AKI stages independently were associated with worse outcome.

Table 1 Classification/staging system for AKI6 modified from RIFLE (Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease) criteria1
Full size table

In summary, AKI appears to negatively influence long-term survival of patients receiving myeloablative HCT, and this effect is particularly relevant in severe AKI. As such, strategies to preserve renal function in patients receiving myeloablative HCT could have a positive impact on patient outcome.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

References

  1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, The ADQI Workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204–R212.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006; 10: R73.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C . An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006; 34: 2016–2017.

    Article  Google Scholar 

  4. Lopes JA, Fernandes J, Jorge S, Neves J, Antunes F, Martins Prata M . An assessment of the RIFLE criteria for ARF in critically ill HIV-infected patients. Crit Care 2007; 1: 401.

    Google Scholar 

  5. Lopes JA, Jorge S, Resina C, Santos C, Pereira A, Neves J et al. Prognostic utility of RIFLE for acute renal failure in patients with sepsis. Crit Care 2007; 11: 408.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al., The Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lopes JA, Jorge S, Silva S, de Almeida E, Abreu F, Martins C et al. An assessment of the RIFLE criteria for acute renal failure following myeloablative autologous and allogeneic haematopoietic cell transplantation. Bone Marrow Transplant 2006; 38: 395.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisboa, Portugal

    J A Lopes, S Jorge, S Gonçalves, C Resina, S Silva, E de Almeida, F Abreu & M M Prata

  2. Department of Hematology, Hospital de Santa Maria, Lisboa, Portugal

    F Lourenço, C Martins, J F Lacerda & J A do Carmo

Authors
  1. J A Lopes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Jorge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Gonçalves
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C Resina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E de Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F Lourenço
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J F Lacerda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J A do Carmo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M M Prata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J A Lopes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lopes, J., Jorge, S., Gonçalves, S. et al. Contemporary analysis of the influence of acute kidney injury (AKI) after myeloablative hematopoietic cell transplantation on long-term patient's survival. Bone Marrow Transplant 42, 139–141 (2008). https://doi.org/10.1038/bmt.2008.97

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2008.97

This article is cited by

Search

Advanced search

Quick links