Kidney function after nonmyeloablative hematopoietic cell transplant for sickle cell disease

Area of Science:

• Nephrology
• Hematology
• Transplantation Medicine

Background:

• Sickle cell disease (SCD) and hematopoietic cell transplantation (HCT) can both lead to kidney damage.
• Understanding the long-term renal effects of HCT in SCD patients is crucial for managing post-transplant care.

Purpose of the Study:

• To evaluate the incidence and progression of kidney damage in patients with SCD undergoing nonmyelablative HCT.
• To assess changes in estimated glomerular filtration rate (eGFR) and other markers of renal function post-HCT.

Main Methods:

• Retrospective analysis of 160 SCD patients who received nonmyelablative HCT.
• Renal function was monitored annually for 3 years, assessing eGFR, albuminuria, and acute kidney injury (AKI).

Main Results:

• The rate of new-onset eGFR <60 ml/min/1.73m² was low (2.8%).
• A transient decline in eGFR was observed post-HCT, but mean eGFR remained within normal limits throughout follow-up.
• Hyperfiltration decreased, and albuminuria was the primary cause of transient kidney damage; AKI occurred in 39% of patients, associated with decreased survival.

Conclusions:

• Nonmyelablative HCT for SCD appears to have a low risk of significant new-onset kidney damage, with eGFR declines potentially indicating renal preservation.
• Early AKI post-HCT is a concern and warrants further investigation due to its association with reduced survival.