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Zheng J, Gong S, Wu G, Zheng X, Li J, Nie J, Liu Y, Chen B, Liu Y, Su Z, Chen J, Li Y. Berberine attenuates uric acid-induced cell injury by inhibiting NLRP3 signaling pathway in HK-2 cells. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:2405-2416. [PMID: 37193772 PMCID: PMC10497693 DOI: 10.1007/s00210-023-02451-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/27/2023] [Indexed: 05/18/2023]
Abstract
Hyperuricemia (HUA) is a common chronic metabolic disease that can cause renal failure and even death in severe cases. Berberine (BBR) is an isoquinoline alkaloid derived from Phellodendri Cortex with strong antioxidant, anti-inflammatory, and anti-apoptotic properties. The purpose of this study was to investigate the protective effects of berberine (BBR) against uric acid (UA)-induced HK-2 cells and unravel their regulatory potential mechanisms. The CCK8 assay was carried out to detect cell viability. The expression levels of inflammatory factors interleukin-1β (IL-1β) and interleukin-18 (IL-18) and Lactate dehydrogenase (LDH) were measured using Enzyme-linked immunosorbent assays (ELISA). The expression of the apoptosis-related protein (cleaved-Caspase3, cleaved-Caspase9, BAX, BCL-2) was detected by western blot. The effects of BBR on the activities of the NOD-like receptor family pyrin domain containing 3 (NLRP3) and the expression of the downstream genes were determined by RT-PCR and western blot in HK-2 cells. From the data, BBR significantly reversed the up-regulation of inflammatory factors (IL-1β, IL-18) and LDH. Furthermore, BBR down-regulated protein expression of pro-apoptotic proteins BAX, cleaved caspase3 (cl-Caspase3), cleaved caspase9 (cl-Caspase9), and enhanced the expression of antiapoptotic protein BCL-2. Simultaneously, BBR inhibited the activated NLPR3 and reduced the mRNA levels of NLRP3, Caspase1, IL-18, and IL-1β. Also, BBR attenuated the expression of NLRP3 pathway-related proteins (NLRP3, ASC, Caspase1, cleaved-Caspase1, IL-18, IL-1β, and GSDMD). Furthermore, specific NLRP3-siRNA efficiently blocked UA-induced the level of inflammatory factors (IL-1β, IL-18) and LDH and further inhibited activated NLRP3 pathway. Collectively, our results suggested that BBR can alleviate cell injury induced by UA. The underlying unctionary mechanism may be through the NLRP3 signaling pathway.
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Affiliation(s)
- Jingna Zheng
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
| | - Shiting Gong
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
| | - Gong Wu
- Department of TCM Orthopedics & Traumatology, Orthopedic Hospital of Longgang, Shenzhen, 518116 Guangdong China
| | - Xiaohong Zheng
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
| | - Jincan Li
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
| | - Juan Nie
- Medical School, Hubei Minzu University, Enshi, 445000 Hubei China
| | - Yanlu Liu
- School of Food and Pharmaceutical Engineering, Zhaoqing University, Zhaoqing, 526040 Guangdong China
| | - Baoyi Chen
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
| | - Yuhong Liu
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
- Dongguan Institute of Guangzhou University of Chinese Medicine, Dongguan, 523808 Guangdong China
| | - Ziren Su
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
- Dongguan Institute of Guangzhou University of Chinese Medicine, Dongguan, 523808 Guangdong China
| | - Jiannan Chen
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
- Dongguan Institute of Guangzhou University of Chinese Medicine, Dongguan, 523808 Guangdong China
| | - Yucui Li
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega Center, 232# Wai Huan East Road, Guangzhou, 510006 Guangdong China
- Dongguan Institute of Guangzhou University of Chinese Medicine, Dongguan, 523808 Guangdong China
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Mahfooz K, Sohail H, Gvajaia A, Arif U, Grewal D, Muppidi MR, Vohra V, Tarique A, Vasavada A. Rasburicase in treating tumor lysis syndrome: An umbrella review. CANCER PATHOGENESIS AND THERAPY 2023; 1:262-271. [PMID: 38327601 PMCID: PMC10846299 DOI: 10.1016/j.cpt.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 02/09/2024]
Abstract
Tumor lysis syndrome (TLS) remains a debilitating cause of hospitalization and death in patients with cancer and is a significant challenge for healthcare providers despite advancements in its management. This umbrella review analyzed the results of meta-analyses on the use of rasburicase in the treatment of patients with cancer. A literature search was performed of five databases (PubMed, Google Scholar, Cochrane Library, Scopus, Global Index Medicus, and ScienceDirect) for articles with full texts available online. A measurement tool to assess systematic reviews 2 (AMSTAR 2) was used to assess the quality of the included studies, and Review Manager software was used to conduct all statistical analyses. The systematic search identified eight relevant meta-analyses, with primary analyses including outcome data that analyzed mortality, renal failure, and comparisons with allopurinol. The pooled data showed that rasburicase effectively reduced TLS development and serum uric acid levels in children and adults with malignancies. Most outcomes did not differ significantly compared with those of allopurinol. Future trials should focus on the cost-effectiveness of rasburicase compared to that of allopurinol while including high-, intermediate-, and low-risk patients. Rasburicase is safe and effective for managing patients with TLS. However, recent large-scale meta-analyses have reported conflicting results. Most meta-analyses were graded as low to critically low as per AMSTAR 2. The analysis revealed that the benefit of rasburicase did not differ significantly from that of allopurinol, which has higher cost-effectiveness and fewer side effects.
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Affiliation(s)
- Kamran Mahfooz
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Haris Sohail
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Ani Gvajaia
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Uroosa Arif
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Daisy Grewal
- Department of Internal Medicine, St. Georges University, St. Georges, Grenada
| | - Monica Reddy Muppidi
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Vanya Vohra
- Department of Pediatrics, St Barnabas Hospital, Bronx, NY, 10457, USA
| | - Aamir Tarique
- Department of Medicine, ESIC Medical College, Faridabad, 121001, India
| | - Advait Vasavada
- Department of Medicine, MP Shah Medical College, Jamnagar, 361008, India
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Biró E, Erdélyi D, Varga P, Sinkó M, Bartyik K, Kovács G, Ottóffy G, Vincze F, Szegedi I, Kiss C, Szabó T. Daily serum phosphate increase as early and reliable indicator of kidney injury in children with leukemia and lymphoma developing tumor lysis syndrome. Pediatr Nephrol 2023; 38:3117-3127. [PMID: 36943467 PMCID: PMC10432329 DOI: 10.1007/s00467-023-05923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Tumor lysis syndrome (TLS) and its most serious complication, acute kidney injury (AKI) are one of the emergency conditions in onco-hematology. It is difficult to predict the degree of kidney involvement. Therefore, we studied children with leukemia and lymphoma treated in four Hungarian tertiary centers (inpatient university clinics) retrospectively (2006-2016) from a nephrological aspect. METHOD Data of 31 pediatric patients were obtained from electronic- and paper-based medical records. Physical status, laboratory test results, treatments, and outcomes were assessed. Patients were analyzed according to both "traditional" TLS groupings, as laboratory TLS or clinical TLS, and nephrological aspect based on pRIFLE classification, as mild or severe AKI. RESULTS Significant differences were found between the changes in parameters of phosphate homeostasis and urea levels in both classifications. Compared to age-specific normal phosphate ranges, before the development of TLS, hypophosphatemia was common (19/31 cases), while in the post-TLS period, hyperphosphatemia was observed (26/31 cases) most frequently. The rate of daily change in serum phosphate level was significant in the nephrological subgroups, but peaks of serum phosphate level show only a moderate increase. The calculated cut-off value of daily serum phosphate level increased before AKI was 0.32 mmol/L per ROC analysis for severe TLS-AKI. The 24-h urinalysis data of eight patients revealed transiently increased phosphate excretion only in those patients with TLS in whom serum phosphate was elevated in parallel. CONCLUSION Daily serum phosphate level increase can serve as a prognostic factor for the severity of pediatric TLS, as well as predict the severity of kidney involvement. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Erika Biró
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4032, Hungary
| | - Dániel Erdélyi
- 2nd Department of Pediatrics, Faculty of Medicine, Semmelweis University, 7-9 Tűzoltó U, Budapest, 1094, Hungary
| | - Petra Varga
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4032, Hungary
| | - Mária Sinkó
- Department of Pediatrics, Albert Szent-Györgyi Health Centre and University, 14-15 Korányi Fasor, Szeged, Hungary, 6725
| | - Katalin Bartyik
- Department of Pediatrics, Albert Szent-Györgyi Health Centre and University, 14-15 Korányi Fasor, Szeged, Hungary, 6725
| | - Gábor Kovács
- 2nd Department of Pediatrics, Faculty of Medicine, Semmelweis University, 7-9 Tűzoltó U, Budapest, 1094, Hungary
| | - Gábor Ottóffy
- Department of Pediatrics, Medical School, University of Pécs, 7. József Attila U, Pécs, 7623, Hungary
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 1. Egyetem Tér, Debrecen, 4032, Hungary
| | - István Szegedi
- Division of Pediatric Haematology-Oncology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4028, Hungary
| | - Csongor Kiss
- 2nd Department of Pediatrics, Faculty of Medicine, Semmelweis University, 7-9 Tűzoltó U, Budapest, 1094, Hungary
| | - Tamás Szabó
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4032, Hungary.
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Ma Q, Immler R, Pruenster M, Sellmayr M, Li C, von Brunn A, von Brunn B, Ehmann R, Wölfel R, Napoli M, Li Q, Romagnani P, Böttcher RT, Sperandio M, Anders HJ, Steiger S. Soluble uric acid inhibits β2 integrin-mediated neutrophil recruitment in innate immunity. Blood 2022; 139:3402-3417. [PMID: 35303071 PMCID: PMC11022987 DOI: 10.1182/blood.2021011234] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
Neutrophils are key players during host defense and sterile inflammation. Neutrophil dysfunction is a characteristic feature of the acquired immunodeficiency during kidney disease. We speculated that the impaired renal clearance of the intrinsic purine metabolite soluble uric acid (sUA) may account for neutrophil dysfunction. Indeed, hyperuricemia (HU, serum UA of 9-12 mg/dL) related or unrelated to kidney dysfunction significantly diminished neutrophil adhesion and extravasation in mice with crystal- and coronavirus-related sterile inflammation using intravital microscopy and an air pouch model. This impaired neutrophil recruitment was partially reversible by depleting UA with rasburicase. We validated these findings in vitro using either neutrophils or serum from patients with kidney dysfunction-related HU with or without UA depletion, which partially normalized the defective migration of neutrophils. Mechanistically, sUA impaired β2 integrin activity and internalization/recycling by regulating intracellular pH and cytoskeletal dynamics, physiological processes that are known to alter the migratory and phagocytic capability of neutrophils. This effect was fully reversible by blocking intracellular uptake of sUA via urate transporters. In contrast, sUA had no effect on neutrophil extracellular trap formation in neutrophils from healthy subjects or patients with kidney dysfunction. Our results identify an unexpected immunoregulatory role of the intrinsic purine metabolite sUA, which contrasts the well-known immunostimulatory effects of crystalline UA. Specifically targeting UA may help to overcome certain forms of immunodeficiency, for example in kidney dysfunction, but may enhance sterile forms of inflammation.
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Affiliation(s)
- Qiuyue Ma
- Division of Nephrology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Roland Immler
- Walter-Brendel-Center of Experimental Medicine, Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Monika Pruenster
- Walter-Brendel-Center of Experimental Medicine, Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Markus Sellmayr
- Division of Nephrology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Chenyu Li
- Division of Nephrology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Albrecht von Brunn
- Max von Pettenkofer-Institute, Ludwig-Maximilians-University (LMU) Munich and German Center for Infection Research (DZIF), Munich, Germany
| | - Brigitte von Brunn
- Max von Pettenkofer-Institute, Ludwig-Maximilians-University (LMU) Munich and German Center for Infection Research (DZIF), Munich, Germany
| | - Rosina Ehmann
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - Roman Wölfel
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - Matteo Napoli
- Walter-Brendel-Center of Experimental Medicine, Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Qiubo Li
- Division of Nephrology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Paola Romagnani
- Department of Biomedical Experimental and Clinical Sciences “Maria Serio,” University of Florence, Florence, Italy
| | - Ralph Thomas Böttcher
- Department of Molecular Medicine, Max Planck Institute for Biochemistry, Martinsried, Germany
| | - Markus Sperandio
- Walter-Brendel-Center of Experimental Medicine, Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
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Abdel-Nabey M, Chaba A, Serre J, Lengliné E, Azoulay E, Darmon M, Zafrani L. Tumor lysis syndrome, acute kidney injury and disease-free survival in critically ill patients requiring urgent chemotherapy. Ann Intensive Care 2022; 12:15. [PMID: 35166948 PMCID: PMC8847484 DOI: 10.1186/s13613-022-00990-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/04/2022] [Indexed: 12/12/2022] Open
Abstract
Background Tumor lysis syndrome (TLS) is a life-threatening complication during the treatment of malignant neoplasia. We sought to describe characteristics and predictors of acute kidney injury (AKI), remission and mortality in high-risk TLS patients. In this retrospective monocentric study, we included all patients with the diagnosis of biological and/or clinical TLS from 2012 to 2018. The primary outcome was the prevalence of AKI during the acute phase of TLS. Secondary outcomes were overall mortality and remission of the underlying malignancy at 1 year. Results Among 153 patients with TLS, 123 (80.4%) patients experienced AKI and 83 (54.2%) required renal replacement therapy. mSOFA score (OR = 1.15, IC 95% [1.02–1.34]), age (OR = 1.05, IC 95% [1.02–1.08]) and male gender (OR = 6.79, IC 95% [2.59–19.44]) were associated with AKI. Rasburicase use (HR = 2.45, IC 95% [1.17–5.15]) was associated with remission of the underlying malignancy at 1 year. Parameters associated with mortality at 1 year were mechanical ventilation (HR = 1.96, IC 95% [1.02–3.78]), vasopressors (HR = 3.13, IC 95% [1.59–6.15]), age (HR = 1.02, IC 95% [1–1.03]), spontaneous TLS (HR = 1.65, IC 95% [1.01–2.69]) and delay of chemotherapy administration (HR = 1.01, IC 95% [1–1.03]). Conclusions AKI is highly prevalent in TLS patients. Rasburicase is associated with better outcomes regarding remission of the underlying malignancy. As rasburicase may be an indirect marker of a high degree of tumor lysis and chemosensitivity, more studies are warranted to confirm the protective role of urate oxidase. Delaying chemotherapy may be deleterious in terms of long-term outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00990-1.
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Affiliation(s)
- Moustafa Abdel-Nabey
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Anis Chaba
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Justine Serre
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Etienne Lengliné
- University of Paris, Paris, France.,Hematology Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France. .,University of Paris, Paris, France. .,INSERM UMR 976, University of Paris, Paris, France.
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Niforatos JD, Zheutlin AR, Chaitoff A, Hilal T. Things We Do for No Reason™: Rasburicase for Adult Patients With Tumor Lysis Syndrome. J Hosp Med 2021; 16:424-427. [PMID: 34197308 DOI: 10.12788/jhm.3618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/13/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Joshua D Niforatos
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander R Zheutlin
- Department of Internal Medicine, University of Utah Hospital and Clinics, Salt Lake City, Utah
| | - Alexander Chaitoff
- Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Talal Hilal
- Department of Hematology/Oncology, University of Mississippi Medical Center, Jackson, Mississippi
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May HP, Barreto EF, Mara KC, McCullough KB, Patnaik MS, Leung N, Habermann TM. Risk for Significant Kidney Function Decline After Acute Kidney Injury in Adults With Hematologic Malignancy. Kidney Int Rep 2021; 6:1050-1057. [PMID: 33912755 PMCID: PMC8071647 DOI: 10.1016/j.ekir.2020.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Acute kidney injury (AKI) affects 30% of adults hospitalized with hematologic malignancy. Little is known about the long-term impact on kidney outcomes in this population despite the close relationship between kidney function and malignancy treatment eligibility. The purpose of this population-based cohort study was to determine the effect of AKI on kidney function in the year following a new diagnosis of acute leukemia or lymphoma. Methods Participants were adults hospitalized within 3 weeks of malignancy diagnosis. Baseline kidney function was determined and AKI diagnosed using standardized criteria. Cox proportional hazard modeling examined the relationship between AKI and a ≥30% decline in estimated glomerular filtration rate (eGFR) from baseline in the 1 year following hospitalization as the primary endpoint. Results AKI occurred in 33% of 1064 participants, with 70% of episodes occurring within 48 hours of hospitalization, and significantly increased risk for a ≥ 30% decline in eGFR (hazard ratio [HR] 2.7, 95% confidence interval [CI] 2.2–3.5) and incident chronic kidney disease (HR 2.2, 95% CI 1.7–2.8). AKI remained a significant predictor of eGFR decline in subgroup and multivariable analyses (adjusted HR 1.9, 95% CI 1.4–2.7). A ≥ 30% decline in eGFR increased the risk for death within 1 year in participants with AKI (HR 2.1, 95% CI 1.3–3.3). Conclusion Results aid in identifying individuals at highest risk for poor outcomes and highlight the need for research involving interventions that preserve kidney function from the time of initial hospitalization with a hematologic malignancy into the postdischarge period.
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Affiliation(s)
- Heather P. May
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
- Correspondence: Heather P. May, Mayo Clinic, 200 First St SW, Rochester, Minnesota 55905-0001, USA.
| | - Erin F. Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Kristin C. Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mrinal S. Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Nephrology and Hypertension and Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M. Habermann
- Division of Nephrology and Hypertension and Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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