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).