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Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States.

Publication ,  Journal Article
Hosing, C; Nash, R; McSweeney, P; Mineishi, S; Seibold, J; Griffith, LM; Shulman, H; Goldmuntz, E; Mayes, M; Parikh, CR; Crofford, L; Furst, D ...
Published in: Biol Blood Marrow Transplant
May 2011

Recipients of hematopoietic cell transplantation may be at risk for developing acute kidney injury (AKI), and this risk may be increased in patients who undergo transplantation for severe systemic sclerosis (SSc) due to underlying scleroderma renal disease. AKI after transplantation can increase treatment-related mortality. To better define these risks, we analyzed 91 patients with SSc who were enrolled in 3 clinical trials in the United States of autologous or allogeneic hematopoietic cell transplantation (HCT). Eleven (12%) of the 91 patients with SSc in these studies (8 undergoing autologous HCT, 1 undergoing allogeneic HCT, 1 pretransplantation, 1 given i.v. cyclophosphamide on a transplantation trial) experienced AKI, of whom 8 required dialysis and/or therapeutic plasma exchange. AKI injury in the 9 HCT recipients developed a median of 35 days (range, 0-90 days) after transplantation. Ten of 11 patients with AKI received angiotensin-converting enzyme inhibitor (ACE-I) therapy. The etiology of AKI was attributed to scleroderma renal crisis in 6 patients (including 2 with normotensive renal crisis), to AKI of uncertain etiology in 2 patients, and to AKI superimposed on scleroderma kidney disease in 3 patients. Eight of the 11 patients died, one each because of progression of SSc, multiorgan failure, gastrointestinal and pulmonary bleeding, pericardial tamponade and pulmonary complications, diffuse alveolar hemorrhage, pulmonary embolism, graft-versus-host disease, and malignancy. Limiting nephrotoxins, cautious use of corticosteroids, renal shielding during total body irradiation, strict control of blood pressure, and aggressive use of ACE-Is may be of importance in preventing renal complications after HCT for SSc.

Duke Scholars

Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

May 2011

Volume

17

Issue

5

Start / End Page

674 / 681

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • United States
  • Transplantation, Homologous
  • Transplantation, Autologous
  • Transplantation Conditioning
  • Survival Analysis
  • Scleroderma, Systemic
  • Scleroderma, Localized
  • Risk Factors
  • Renal Dialysis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hosing, C., Nash, R., McSweeney, P., Mineishi, S., Seibold, J., Griffith, L. M., … Sullivan, K. M. (2011). Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States. Biol Blood Marrow Transplant, 17(5), 674–681. https://doi.org/10.1016/j.bbmt.2010.08.003
Hosing, Chitra, Richard Nash, Peter McSweeney, Shin Mineishi, James Seibold, Linda M. Griffith, Howard Shulman, et al. “Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States.Biol Blood Marrow Transplant 17, no. 5 (May 2011): 674–81. https://doi.org/10.1016/j.bbmt.2010.08.003.
Hosing C, Nash R, McSweeney P, Mineishi S, Seibold J, Griffith LM, et al. Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States. Biol Blood Marrow Transplant. 2011 May;17(5):674–81.
Hosing, Chitra, et al. “Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States.Biol Blood Marrow Transplant, vol. 17, no. 5, May 2011, pp. 674–81. Pubmed, doi:10.1016/j.bbmt.2010.08.003.
Hosing C, Nash R, McSweeney P, Mineishi S, Seibold J, Griffith LM, Shulman H, Goldmuntz E, Mayes M, Parikh CR, Crofford L, Keyes-Elstein L, Furst D, Steen V, Sullivan KM. Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States. Biol Blood Marrow Transplant. 2011 May;17(5):674–681.
Journal cover image

Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

May 2011

Volume

17

Issue

5

Start / End Page

674 / 681

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • United States
  • Transplantation, Homologous
  • Transplantation, Autologous
  • Transplantation Conditioning
  • Survival Analysis
  • Scleroderma, Systemic
  • Scleroderma, Localized
  • Risk Factors
  • Renal Dialysis