1
|
Li Z, Liu J, Jing B, Shen W, Liu P, Liu Y, Han Z. Incidence of acute kidney injury after hematopoietic stem cell transplantation in children: a systematic review and meta-analysis. Eur J Pediatr 2023; 182:3511-3517. [PMID: 37191691 DOI: 10.1007/s00431-023-05018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
While acute kidney injury (AKI) has been reported after hematopoietic stem cell transplantation (HCT) in children, the incidence of this condition in the pediatric population has not been fully addressed. To assess the incidence of pediatric AKI after HCT treatment,we conducted a systematic literature review. Databases PubMed, Embase, Cochrane Library, and WOS were searched as of June 2022 to identify studies on the incidence and the risk of death in AKI children undergoing HCT. Random effects and generic inverse variance methods were used, and effect estimates were subsequently derived from individual studies. Twelve cohort studies with 2 159 HCT cases were included in this analysis. The combined estimated incidence of AKI and severe AKI (stage AKI III) was 51% (95% confidence interval (CI) 39-64%) and 12% (95%CI 4-24%), respectively. The estimated incidence of AKI based on RIFLE (pRIFLE), AKIN, and KDIGO criteria was 61% (95%CI 40-82% score I 95.1%), 64% (95%CI 49-79% score I 90.4%), and 51% (95%CI 2-100% score 99.0%), respectively. However, we found no significant correlation between the years of publication of the included studies and the incidence of AKI. Conclusions: AKI affects approximately half of the children after HCT. With the advancements in medical techniques, it is expected that AKI in this population will decrease gradually. What is Known: • Hematopoietic stem cell transplantation is recognized as a treatment for malignant and non-malignant diseases in children. • Hematopoietic stem cell transplantation causes acute kidney injury in children. What is New: • This metanalysis showed that the overall frequency of post-HCT AKI in children is 51%. • The frequency of severe AKI after HCT was found to be 12%.
Collapse
Affiliation(s)
- Zhuoyu Li
- Department of Pediatric, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453399, China
| | - Jia Liu
- Department of Pediatric, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453399, China
| | - Bo Jing
- Department of Pediatric, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453399, China
| | - Wenlong Shen
- Department of Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453399, China
| | - Pei Liu
- Department of Pediatric, Dongguan Maternal and Child Health Hospital, Dongguan, 523057, China
| | - Yaqian Liu
- Department of Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453399, China
| | - Ziming Han
- Department of Pediatric, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453399, China.
| |
Collapse
|
2
|
Farhadfar N, Dias A, Wang T, Fretham C, Chhabra S, Murthy HS, Broglie L, D'Souza A, Gadalla SM, Gale RP, Hashmi S, Al-Homsi AS, Hildebrandt GC, Hematti P, Rizzieri D, Chee L, Lazarus HM, Bredeson C, Jaimes EA, Beitinjaneh A, Bashey A, Prestidge T, Krem MM, Marks DI, Benoit S, Yared JA, Nishihori T, Olsson RF, Freytes CO, Stadtmauer E, Savani BN, Sorror ML, Ganguly S, Wingard JR, Pasquini M. Impact of Pretransplantation Renal Dysfunction on Outcomes after Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:410-422. [PMID: 33775617 DOI: 10.1016/j.jtct.2021.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/16/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023]
Abstract
Renal dysfunction is a recognized risk factor for mortality after allogeneic hematopoietic cell transplantation (alloHCT), yet our understanding of the effect of different levels of renal dysfunction at time of transplantation on outcomes remains limited. This study explores the impact of different degrees of renal dysfunction on HCT outcomes and examines whether the utilization of incremental degrees of renal dysfunction based on estimated glomerular filtration rate (eGFR) improve the predictability of the hematopoietic cell transplantation comorbidity index (HCT-CI). The study population included 2 cohorts: cohort 1, comprising patients age ≥40 years who underwent alloHCT for treatment of hematologic malignancies between 2008 and 2016 (n = 13,505; cohort selected given a very low incidence of renal dysfunction in individuals age <40 years), and cohort 2, comprising patients on dialysis at the time of HCT (n = 46). eGFR was measured using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) method. The patients in cohort 1 were assigned into 4 categories-eGFR ≥90 mL/min (n = 7062), eGFR 60 to 89 mL/min (n = 5264), eGFR 45 to 59 mL/min (n = 897), and eGFR <45 mL/min (n=282)-to assess the impact of degree of renal dysfunction on transplantation outcomes. Transplantation outcomes in patients on dialysis at the time of alloHCT were analyzed separately. eGFR <60 mL/min was associated with an increased risk for nonrelapse mortality (NRM) and requirement for dialysis post-HCT. Compared with the eGFR ≥90 group, the hazard ratio (HR) for NRM was 1.46 (P = .0001) for the eGFR 45 to 59 mL/min group and 1.74 (P = .004) for the eGFR <45 mL/min group. Compared with the eGFR ≥90 mL/min group, the eGFR 45 to 59 mL/min group (HR, 2.45; P < .0001) and the eGFR <45 mL/min group (HR, 3.09; P < .0001) had a higher risk of renal failure necessitating dialysis after alloHCT. In addition, eGFR <45 mL/min was associated with an increased overall mortality (HR, 1.63; P < .0001). An eGFR-based revised HCT-CI was also developed and shown to be predictive of overall survival (OS) and NRM, with predictive performance similar to the original HCT-CI. Among 46 patients on dialysis at alloHCT, the 1-year probability of OS was 20%, and that of NRM was 67%. The degree of pretransplantation renal dysfunction is an independent predictor of OS, NRM, and probability of needing dialysis after alloHCT. An eGFR-based HCT-CI is a validated index for predicting outcomes in adults with hematologic malignancies undergoing alloHCT. The outcomes of alloHCT recipients on dialysis are dismal; therefore, one should strongly weigh the significant risks of being on hemodialysis as a factor in determining alloHCT candidacy.
Collapse
Affiliation(s)
- Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tao Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caitrin Fretham
- CIBMTR (Center for International Blood and Marrow Transplant Research), National marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Larisa Broglie
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shahinaz M Gadalla
- Division of Cancer Epidemiology & Genetics, NIH-NCI Clinical Genetics Branch, Rockville, Maryland
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | | | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Lynette Chee
- The Royal Melbourne Hospital City Campus and Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Edgar A Jaimes
- Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami, Miami, Florida
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Maxwell M Krem
- Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Stefanie Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, Florida
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | | | - Edward Stadtmauer
- Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Marcelo Pasquini
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
3
|
Tay J, Daly A, Jamani K, Labelle L, Savoie L, Stewart D, Storek J, Beattie S. Patient eligibility for hematopoietic stem cell transplantation: a review of patient-associated variables. Bone Marrow Transplant 2018; 54:368-382. [PMID: 29988063 DOI: 10.1038/s41409-018-0265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/30/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023]
Abstract
Assessing patient eligibility for hematopoietic stem cell transplantation (HSCT) remains a complex, multifaceted challenge. Among these challenges, the paucity of comprehensive clinical data to guide decision making remains problematic coupled with unclear trade-offs between patient, disease and local HSCT center factors. Moreover, it is unclear that the modification of poor patient characteristics will improve post-HSCT outcomes. However, the use of Comorbidity Indices and Comprehensive Geriatric Assessments helps meet this challenge, but may be limited by overlapping patient characteristics. The increasing consideration for pre-HSCT psychosocial assessments and interventions remains to be studied. Ultimately, the decision to proceed with a HSCT remains interdisciplinary while considering the available evidence discussed in this review.
Collapse
Affiliation(s)
- J Tay
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
| | - A Daly
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - K Jamani
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Labelle
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Savoie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - D Stewart
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - J Storek
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - S Beattie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
4
|
Mild renal dysfunction defined by creatinine clearance rate has limited impact on clinical outcomes after allogeneic hematopoietic stem cell transplantation. Int J Hematol 2018; 107:568-577. [DOI: 10.1007/s12185-017-2398-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022]
|
5
|
Wada H, Kanda J, Akahoshi Y, Nakano H, Ugai T, Yamasaki R, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Sato M, Terasako-Saito K, Kimura SI, Kikuchi M, Nakasone H, Yamazaki R, Kako S, Tanihara A, Nishida J, Kanda Y. Impact of estimated glomerular filtration rate based on plasma cystatin C and serum creatinine levels before allogeneic hematopoietic cell transplantation. ACTA ACUST UNITED AC 2017; 23:271-276. [PMID: 29086660 DOI: 10.1080/10245332.2017.1396026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND No standard method for measuring renal function has been established in allogeneic hematopoietic cell transplantation (allo-HCT). METHODS We retrospectively analyzed 80 patients with hematological diseases who underwent allo-HCT at our center. We assessed renal function using creatinine clearance (Ccr), estimated glomerular filtration rate (eGFR) based on creatinine (eGFRcre), eGFR based on cystatin C (eGFRcys), and the average of eGFRcre and eGFRcys (eGFRave). We then evaluated the impact of pre-transplant renal function on the exacerbation of renal function and non-relapse mortality after transplantation. RESULTS There was a significant correlation between Ccr and eGFRcre, eGFRcys, and eGFRave. eGFRave best predicted the exacerbation of renal function according to the area under the receiver-operating characteristic curve. The cumulative incidence of renal function exacerbation at 1 year was higher in the lower eGFRave group (<90 ml/min/1.73 m2) than in the higher eGFRave group (≥90 ml/min/1.73 m2; 0.85 vs. 0.39, p < 0.001), which was confirmed by a multivariate analysis (HR 2.75, p = 0.001). A lower eGFRave value was a marginally significant factor for non-relapse mortality (HR 3.29, p = 0.076). CONCLUSION Among the four parameters, eGFRave best predicted the exacerbation of renal function in allo-HCT. Further, the marginal association between low eGFRave and high non-relapse mortality warrants further study in a prospective study in allo-HCT.
Collapse
Affiliation(s)
- Hidenori Wada
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Junya Kanda
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Yu Akahoshi
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Hirofumi Nakano
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Tomotaka Ugai
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Ryoko Yamasaki
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Yuko Ishihara
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Koji Kawamura
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Kana Sakamoto
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Masahiro Ashizawa
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Miki Sato
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Kiriko Terasako-Saito
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Shun-Ichi Kimura
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Misato Kikuchi
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Hideki Nakasone
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Rie Yamazaki
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Shinichi Kako
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Aki Tanihara
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Junji Nishida
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| | - Yoshinobu Kanda
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama City , Japan
| |
Collapse
|
6
|
Yang Y, Li HY, Zhou Q, Peng ZW, An X, Li W, Xiong LP, Yu XQ, Jiang WQ, Mao HP. Renal Function and All-Cause Mortality Risk Among Cancer Patients. Medicine (Baltimore) 2016; 95:e3728. [PMID: 27196494 PMCID: PMC4902436 DOI: 10.1097/md.0000000000003728] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Renal dysfunction predicts all-cause mortality in general population. However, the prevalence of renal insufficiency and its relationship with mortality in cancer patients are unclear.We retrospectively studied 9465 patients with newly diagnosed cancer from January 2010 to December 2010. Renal insufficiency was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m using the Chronic Kidney Disease Epidemiology Collaboration equation. The hazard ratio (HR) of all-cause mortality associated with baseline eGFR was assessed by Cox regression.Three thousand sixty-nine patients (32.4%) exhibited eGFR <90 mL/min/1.73 m and 3% had abnormal serum creatinine levels at the time of diagnosis. Over a median follow-up of 40.5 months, 2705 patients (28.6%) died. Compared with the reference group (eGFR ≥ 60 mL/min/1.73 m), an elevated all-cause mortality was observed among patients with eGFR < 60 mL/min/1.73 m stratified by cancer stage in the entire cohort, the corresponding hazard ratios were 1.87 (95% CI, 1.41-2.47) and 1.28 (95% CI, 1.01-1.62) for stage I to III and stage IV, respectively. However, this relationship was not observed after multivariate adjustment. Subgroup analysis found that eGFR < 60 mL/min/1.73 m independently predicted death among patients with hematologic (adjusted HR 2.93, 95% CI [1.36-6.31]) and gynecological cancer (adjusted HR 2.82, 95% CI [1.19-6.70]), but not in those with other cancer. Five hundred fifty-seven patients (6%) had proteinuria. When controlled for potential confounding factors, proteinuria was a risk factor for all-cause mortality among patients in the entire cohort, regardless of cancer stage and eGFR values. When patients were categorized by specific cancer type, the risk of all-cause death was only significant in patients with digestive system cancer (adjusted HR, 1.85 [1.48-2.32]).The prevalence of renal dysfunction was common in patients with newly diagnosed cancer. Patients with eGFR < 60 mL/min/1.73 m or proteinuria were associated with increased risk for all-cause mortality, this relation depended on cancer site.
Collapse
Affiliation(s)
- Yan Yang
- From the Department of Nephrology (YY, H-YL, QZ, WL, L-PX, X-QY, H-PM), The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, Guangdong; Department of Oncology (Z-WP), The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong; and Department of Oncology (XA, W-QJ), Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Bodge MN, Reddy S, Thompson MS, Savani BN. Preparative regimen dosing for hematopoietic stem cell transplantation in patients with chronic kidney disease: analysis of the literature and recommendations. Biol Blood Marrow Transplant 2014; 20:908-19. [PMID: 24565993 DOI: 10.1016/j.bbmt.2014.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a potentially life-saving therapy that has traditionally been associated with high treatment-related mortality due to direct regimen toxicity and a high incidence of graft-versus-host disease. Historically, pre-existing renal insufficiency has been considered an exclusion criterion for transplantation. The advent of nonmyeloablative conditioning regimens as a less toxic modality for treatment has made HSCT more accessible to elderly patients and patients with comorbidities, such as renal impairment. However, there is no clear standard for how to dose preparative regimens for patients with chronic renal impairment who undergo HSCT. This article serves as a review of the current literature to provide dosing recommendations for commonly used preparative agents in the setting of chronic kidney disease, with the aim of providing optimal dosing for this patient population.
Collapse
Affiliation(s)
- Megan N Bodge
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Srividya Reddy
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Medical Center, Nashville, Tennessee
| | - Michael Scott Thompson
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bipin N Savani
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Medical Center, Nashville, Tennessee.
| |
Collapse
|