Risk factors for severe acute kidney injury after pediatric hematopoietic cell transplantation

Abbie Bauer, Kristen Carlin, Stephen M. Schwartz, Meera Srikanthan, Monica Thakar, Lauri M. Burroughs, Jodi Smith, Sangeeta Hingorani, Shina Menon

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Acute kidney injury (AKI) is common after hematopoietic cell transplantation (HCT) and is associated with poorer outcomes. Risk factors for AKI after pediatric HCT are not fully understood. The study objective was to assess unique risk factors for AKI in the HCT population and evaluate post-HCT AKI patterns. Methods: We conducted a retrospective cohort study of patients < 21 years of age who underwent HCT at Seattle Children’s Hospital/Fred Hutchinson Cancer Center from September 2008 to July 2017 (n = 484). We defined AKI using KDIGO criteria. We collected demographics, baseline HCT characteristics, post-HCT complications, and mortality. Multinomial logistic regression was used to estimate association between AKI and potential risk factors. We used adjusted Cox proportional hazard ratios to evaluate differences in mortality. Results: One hundred and eighty-six patients (38%) developed AKI. Seventy-nine (42%) had severe AKI and 27 (15%) required kidney replacement therapy. Fluid overload was common in all groups and 67% of those with severe AKI had > 10% fluid overload. Nephrology was consulted in less than 50% of those with severe AKI. In multivariable analysis, risk of severe AKI was lower in those taking a calcineurin inhibitor (CNI). Risk of death was higher in severe AKI compared to no AKI (RR 4.6, 95% CI 2.6–8.1). Conclusions: AKI and fluid overload are common in pediatric patients after HCT. Severe AKI occurred less often with CNI use and was associated with higher mortality. Future interventions to reduce AKI and its associated complications such as fluid overload are approaches to reducing morbidity and mortality after HCT. Graphical abstract: [Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)1365-1372
Number of pages8
JournalPediatric Nephrology
Issue number4
StatePublished - Apr 2023

Bibliographical note

Funding Information:
We thank our colleagues from the Department of Pediatrics, Division of Nephrology and Division of Hematology–Oncology and Bone Marrow Transplant who provided insight and expertise that greatly assisted the research. We would also like to specifically acknowledge Agne Taraseviciute, MD, who assisted in the formation of the initial study design.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to International Pediatric Nephrology Association.


  • Acute kidney injury
  • Calcineurin inhibitors
  • Fluid overload
  • Hematopoietic cell transplantation
  • Pediatrics
  • Risk factors

PubMed: MeSH publication types

  • Journal Article


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