Retrospective evaluation of cystatin C as a measure of renal function in pediatric hematopoietic stem cell transplant patients receiving foscarnet for cytomegalovirus reactivation Journal Article

  

Authors:	Pickett, L. R.; Daukshus, N. P.; Camacho-Bydume, C.; Mathew, S.; Mauguen, A.; Cohen, N.; Cancio, M.
Article Title:	Retrospective evaluation of cystatin C as a measure of renal function in pediatric hematopoietic stem cell transplant patients receiving foscarnet for cytomegalovirus reactivation
Abstract:	BACKGROUND: Cytomegalovirus (CMV) infection following allogeneic hematopoietic cell transplantation has considerable morbidity and mortality, and foscarnet is a treatment option that requires renal dose adjustment. Serum creatinine (SCr)-based estimated glomerular filtration rate (eGFR) equations are used to estimate renal function for patients receiving foscarnet, but cystatin C (cysC) has been shown as a possible alternative. Data examining cysC-based eGFR in this population is sparse. Our primary objective was to evaluate outcomes of patients treated with foscarnet dosed utilizing cysC-based eGFR versus SCr-based eGFR. METHODS: We analyzed patients on the transplantation and cellular therapies service at Memorial Sloan Kettering Kids from January 2011 to September 2021 who received allogeneic hematopoietic cell transplantation and ≥14 days of foscarnet for CMV infection. Patients with cysC-based eGFR were compared to a historical cohort of patients who only had SCr-based eGFR. Outcomes included time to CMV clearance, death or change in anti-CMV therapy. Cumulative incidence curves and cause-specific hazards model were used for analysis. RESULTS: In 61 analyzed patients, no differences were found between the cohorts in cumulative incidence of change in anti-CMV therapy ( P = 0.17) or death ( P = 0.69). After adjustment for multiple confounders, patients in the SCr cohort seemed to have a higher chance of CMV clearance compared with the cysC cohort, but the difference was not statistically significant (hazard ratio = 2.42, P = 0.089). Patients who received corticosteroids appeared to have lower incidence of CMV clearance ( P = 0.056). CONCLUSIONS: We did not find differences in outcomes when dosing foscarnet using cysC versus SCr for treatment of CMV infection. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Keywords:	child; retrospective studies; hematopoietic stem cell transplantation; retrospective study; kidney; antivirus agent; cystatin c; foscarnet; cytomegalovirus infection; cytomegalovirus; antiviral agents; cytomegalovirus infections; humans; human
Journal Title:	The Pediatric infectious disease journal
Volume:	43
Issue:	5
ISSN:	0891-3668
Publisher:	Wolters Kluwer
Date Published:	2024-05-01
Start Page:	457
End Page:	462
Language:	English
DOI:	10.1097/inf.0000000000004238
PUBMED:	38190640
PROVIDER:	scopus
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85191106356&doi=10.1097%2fINF.0000000000004238&partnerID=40&md5=a0741fe22bfa5a80330eee66afa4a88b
Notes:	Article -- Source: Scopus

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