Soluble Urokinase Plasminogen Activator Receptor and Acute Kidney Injury in Hematopoietic Cell Transplantation.

Acute kidney injury (AKI) frequently follows hematopoietic cell transplantation (HCT). Soluble urokinase-type plasminogen activator receptor (suPAR) is a biomarker of AKI in the general population. We evaluated suPAR and its association with AKI requiring dialysis (AKI-D) in patients undergoing allogeneic HCT (alloHCT). Performance of suPAR was compared to serum creatinine (sCr) and neutrophil gelatinase-associated lipocalin (NGAL). Data were obtained from Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 1202 cohort (NCT01879072), an observational study of 1,709 alloHCT recipients. Adults aged 18 or older with AKI-D post HCT were included. Adults who did not develop AKI were included as controls and matched 1:1. Periodic serum samples (7-90 days) were analyzed for NGAL, suPAR, and sCr. The 1:1 matched case-control groups (n = 62 each) were balanced in demographic variables, except for graft-versus-host disease (GVHD) prophylaxis. The median time from transplant to AKI-D was 2.6 months (range 0.03-20.39). Day +7 suPAR after HCT was higher in patients with AKI (median 2.7 ng/mL) compared to controls (2.1 ng/mL) (P = .002). In multivariate analysis, day +7 suPAR was associated with development of AKI-D (P = .009). The area under the curve for the receiver operating characteristic curve for day +7 suPAR levels was 0.75. Neither NGAL nor sCr were associated with AKI-D. Elevated day +7 suPAR levels predicted AKI and lower overall survival (OS). suPAR at day +7 post HCT may be an early prognostic factor for development of AKI-D and OS. Future, prospective studies could evaluate this at different stages of AKI.