Incidence, Risk Factors, and Prognosis of Acute Kidney Injury in Elderly Patients With Acute Leukemia Undergoing Haploidentical Hematopoietic Stem Cell Transplantation

We explored the incidence, risk factors, and clinical characteristics of acute kidney injury (AKI) within 100 days posttransplantation, and its impact on the prognosis of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in elderly patients. A total of 224 elderly patients diagnosed with acute leukemia received haplo-HSCT between January 1, 2019, and December 31, 2023 at Peking University People's Hospital. AKI affected 54.9% of the patients, with 33.5% in Stage 1, 18.3% in Stage 2, and 3.1% in Stage 3. Being female and having hypoalbuminemia were independent risk factors for developing severe AKI. Three-year overall survival for AKI Stages 0, 1, 2, and 3 were 73.4%, 75.9%, 56.6%, and 14.3%, respectively (p = 0.000). The 3-year event-free survival rates were 70.7%, 73.0%, 46.2%, and 0% (p < 0.001). The 3-year transplantation-related mortality was 13.8% for Stages 0-1 and 48.1% for Stages 2-3 (p < 0.001). Our study showed that more than half of elderly patients who underwent haplo-HSCT developed AKI. Being female and having hypoalbuminemia before transplantation were at a significantly higher risk for severe AKI. Experiencing Stage 2 or more severe AKI was found to be an independent risk factor for increased mortality.