Factors associated with AKI
Table 1 compares demographic characteristics stratified by development
of AKI. In the group of patients who had at least 1 episode of AKI, the
mean age at diagnosis was significantly higher (8.5 vs 5.7 years, P =
0.002), and the proportions with impaired initial eGFR < 90
mL/min/1.73 m2 (21.4% vs 5.4%, P = 0.026) and septic
shock (35.7% vs 3.6%, P < 0.05) were significantly higher
compared to the group who did not develop AKI. Six patients (5.4%) were
diagnosed with tumor lysis syndrome at the initial AML diagnosis and all
of them developed AKI during their first admission. The median time from
the first visit to the first AKI episode was 12.5 days (IQR 2.8-20.8).
The association between AKI and chemotherapy protocol was not
significant; however, AKI occurred more frequently among those treated
with the BFM-83 protocol than the other two protocols while patients
receiving the Children’s Oncology Group regimen had the lowest
proportion of AKI incidents.
On multivariate analysis, septic shock was the most important risk
factor of AKI, followed by impaired renal function before initiation of
chemotherapy and age at diagnosis ≥ 10 years (Table 2).