Introduction: Allogeneic hematopoietic cell transplantation (allo-HSCT)-associated thrombotic microangiopathy (TA-TMA) and pre-transplant renal dysfunction are recognized risk factors for mortality after allo-HSCT. Utilizing the data from the Center for International Blood and Marrow Transplant Research (CIBMTR), we investigated the association between onset of TA-TMA and pre-HSCT renal dysfunction on renal failure requiring dialysis (RFD). Methods: We evaluated TA-TMA as a time-dependent covariate in a multivariate Cox regression model for RFD in Allo-HSCT recipients aged ≥ 40 years between 2008 and 2016. Pre-HSCT patients were divided into two groups, estimated GFR (eGFR) < 60 mL/min/1.73 m² group and eGFR ≥ 60 mL/min/1.73 m². Cumulative hazards of RFD in patients with and without onset of TA-TMA were estimated. Results: TA-TMA was significantly associated with increased risk (6.6-fold compared to No TA-TMA) for RFD, the highest of all the significant risk factors. The estimated cumulative hazard for patients with TA-TMA in the two pre-HSCT renal function groups was significantly elevated when compared to similar patients with no TA-TMA (80% vs. 12% for eGFR < 60 mL/min and 50% vs. 5% for eGFR ≥ 60 mL/min group, respectively) at 12 months post-HSCT. Conclusions: Our results demonstrate that the adjusted HR of renal failure requiring dialysis and cumulative hazard was much higher in patients with onset of TA-TMA, especially among patients with pre-existing renal dysfunction, underscoring the importance of early recognition and risk-adapted management.

Background: Sepsis in patients with acute myeloid leukemia (AML) is one of the causes of acute kidney injury (AKI). There are no available data on the outcomes of AML-related AKI patients. Methods: We researched the 2016–2020 National Inpatient Sample (NIS) database to collect data on hospitalizations of patients ≥18 years old with sepsis and AML. These admissions were divided into two weighted groups, with and without AKI. A multivariable logistic regression was used with adjustment for possible confounders to generate the adjusted odds ratios for the outcomes of the study. A p-value of <0.05 was considered significant. The primary outcome was all-cause inpatient mortality. Secondary outcomes were septic shock, fluid and electrolyte disorders, length of stay (LOS), vasopressor support, and the requirement for mechanical ventilation. Results: Out of 288,435 hospital admissions of patients with sepsis and AML, 61,955 (21.4%) had AKI. Patients with AKI were older (mean age 66.1 vs. 60.4 years), males (63.1% vs. 52.8%), and more Black individuals were affected (12% vs. 9.2). They also had more comorbidities but had a significantly higher percentage of diabetes mellitus, congestive heart failure, cardiac arrhythmias, cerebrovascular disease, and chronic kidney disease. Tumor lysis syndrome was present in 11.1%. Compared to patients without AKI, patients with AKI had longer LOS days (15.4 ± 18 vs. 10.8 ± 13.1, p < 0.001. Multivariable analysis showed that the patients with AKI had higher odds of mortality (OR: 3.8, 95% CI: 3.6–4.1, p < 0.001). They also had a higher risk for fluid and electrolyte disorders (OR: 2.2, 95% CI: 2.1–2.4, p < 0.001), septic shock (OR: 6.3, 95% CI: 5.7–6.9, p < 0.001), vasopressor requirement (OR: 5.0, 95% CI: 4.3–5.8, p < 0.001), and mechanical ventilation (OR: 5.2, 95% CI: 4.7–5.7, p < 0.001). Conclusions: AKI in patients with sepsis and AML was associated with higher mortality compared to sepsis alone, as well as other complications. Further large studies are required to identify factors that could improve outcomes.