Acute Kidney Injury (AKI) in Adults With Leukemia: A Nationwide Inpatient Retrospective Analysis.

Abstract

Background: Leukemia ranks among the top three cancers in those who have Acute Kidney Injury (AKI), with an incidence of 7.5 % in hematological malignancies. Through this study, we aimed to assess the mortality of severe sepsis (SS), thrombocytopenia, and metabolic encephalopathy (MetE) in Leukemia with AKI.

Methods: We conducted a retrospective analysis using the National Inpatient Sample (2018-2021). Adults with Leukemia primarily admitted with AKI were included, and mortality was calculated. Patients were stratified by SS, thrombocytopenia, and MetE. Propensity matching for age over 60 and gender, and multivariate regression were performed with p ≤ 0.05.

Results: Among 388,449 Leukemia patients, 2.5 % had AKI. The mortality in AML was 7 % and CML was 5.7 %. In Leukemia, mortality risk was lower in the AKI cohort than in those without AKI (aOR 0.04, p < 0.01). In the AKI cohort, individuals aged >60 years showed increased mortality (p < 0.001). Race, gender, hematopoietic stem cell transplant, and inpatient hemodialysis did not alter mortality (p > 0.05). We identified increased mortality risk with SS (aOR 38.2, p < 0.001), thrombocytopenia (aOR 1.8, p < 0.001), and MetE (aOR 3.3, p < 0.001). Additionally, patients with these outcomes required blood transfusions, vasopressors, and invasive ventilation (p < 0.001).

Conclusion: These findings underscore the lower mortality of AKI in Leukemia but highlight higher mortality rates in association with sepsis, thrombocytopenia, and metabolic encephalopathy. Managing AKI also requires appropriate antibiotic selection and a thorough evaluation for bone marrow dysfunction.