Retrospective Study of Acute Kidney Injury Incidence in Patients with Newly Diagnosed Acute Promyelocytic Leukemia

Abstract

Tadashi Kamio,1 Hiroshi Koyama,1 Kiyomitsu Fukaguchi,1 Shuku Sato,2 Wataru Kamata,2 Satomi Okada,2 Yotaro Tamai2 1Division of Critical Care, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, Japan; 2Department of Hematology, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, JapanCorrespondence: Tadashi KamioDivision of Critical Care, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, JapanTel [phone]Fax [phone]Email [email protected]: Acute promyelocytic leukemia (APL) constitutes 5– 10% of all cases of newly diagnosed acute myeloid leukemia. However, data on the epidemiology and risk factors for acute kidney injury (AKI) in patients with newly diagnosed APL are lacking. This study determined the incidence rate of AKI during induction chemotherapy for patients with newly diagnosed APL and the risk factors for AKI.Patients and Methods: We conducted a retrospective observational study of patients with newly diagnosed APL in the Shonan Kamakura General Hospital between April 2004 and April 2020. Data of 27 patients with newly diagnosed APL were analyzed. The patients were classified as no AKI and AKI stages 1, 2 or 3.Results: The incidence rate of AKI during induction chemotherapy was 40% (11/27). Among patients who developed AKI, four patients experienced AKI stage 3, and two patients required renal replacement therapy. No significant differences were found in the white blood cell count and baseline renal function between the groups; however, D-dimer and C-reactive protein levels upon admission were significantly higher in patients with AKI than in patients without AKI. Among patients who developed AKI, in hospital mortality at 90 days was 36% (4/11), which was significantly higher than among patients without AKI (p = 0.02). Patients who developed AKI were administered vancomycin more frequently, while almost all blood culture results were negative.Conclusion: Incidence of AKI development in patients with newly diagnosed APL during induction chemotherapy was approximately 40%. Moreover, patients who developed AKI tended to be administered vancomycin more frequently. Unnecessary use of vancomycin should be avoided in patients with newly diagnosed APL, and using alternative non-nephrotoxic drugs should be considered for patients at risk of AKI.Keywords: acute promyelocytic leukemia, acute kidney injury, incidence rate, induction chemotherapy

Keywords

• acute promyelocytic leukemia
• acute kidney injury
• incidence rate
• induction chemotherapy