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Incidence and risk factors for chronic kidney disease after hematopoietic stem cell transplantation
Alina Tanase1, Andreea Andronesi2,3, Bogdan Sorohan2,3
1Bone Marrow Transplant Department, Fundeni Clinical Institute, Bucharest, Romania.
Insights
Chronic kidney disease (CKD) after hematopoietic stem cell transplantation (HSCT) is a growing concern. Longer disease duration and older age are key risk factors for developing CKD post-transplant.
Area of Science:
- Nephrology
- Hematology
- Transplantation Medicine
Background:
- Chronic kidney disease (CKD) is an increasing complication following hematopoietic stem cell transplantation (HSCT).
- Limited research exists on CKD incidence and risk factors in HSCT survivors.
- Identifying risk factors is crucial for managing this comorbidity.
Purpose of the Study:
- To prospectively evaluate the incidence of CKD in patients undergoing allogeneic HSCT.
- To identify risk factors associated with the development and persistence of low glomerular filtration rate (GFR).
Main Methods:
- Prospective assessment of 197 patients who received allogeneic HSCT.
- Monitoring of glomerular filtration rate (GFR) and identification of persistent low GFR.
- Cox proportional hazard analysis to determine risk factors for CKD.
Main Results:
- CKD incidence was 11.7% with a median onset of 6 months post-HSCT.
- Older age and longer duration of hematologic disease were significant predictors of CKD.
- Acute lymphoblastic leukemia was associated with a reduced risk of developing CKD.
Conclusions:
- CKD is an important comorbidity in improving HSCT survival rates.
- Hematologic disease length and baseline estimated GFR are independent risk factors for renal dysfunction post-HSCT.
Background:
Chronic kidney disease (CKD) in hematopoietic stem cell transplantation (HSCT) is becoming more common. Only few studies were published during the past 10 years. Identification of risk factors is of outmost importance.
Objectives:
We assessed prospectively a cohort of 197 patients who underwent allogeneic HSCT, aiming to evaluate the incidence and risk factors associated with CKD. We registered the persistence of the low GFR. Cox proportional hazard analysis has been used to identify the risk factors.
Main Results:
The mean age was 38.7 years (52.8% female). Acute kidney injury was present in 80% patients within 3 months and CKD incidence was 11.7% with a median onset of 6 months. By univariate Cox regression analysis, age (per 1 year) was the only variable associated with CKD (HR= 1.06, 95%, CI= 1.02-1.10, p = 0.001) and baseline creatinine (per 1 mg/dl) presented a trend of association (HR= 4.62, 95%, CI= 0.75-28.42, p = 0.09). Multivariate Cox regression analysis showed that age (per 1 year; HR= 1.08, 95%, CI = 1.02-1.14, p = 0.003) and hematologic disease length (per 1 month; HR = 1.01, 95%, CI= 1.001-1.02, p = 0.02) were positive predictors for CKD, whereas acute lymphoblastic leukemia (HR= 0.37, 95%, CI= 0.20-0.61, p = 0.02) was a negative predictor factor, being associated with a 63% reduction risk for developing CKD.
Conclusions:
As the prognostic of hematopoietic stem cell transplantation survivors is improving, CKD emerges as an important comorbidity, with hematologic disease length and baseline eGFR being independent risk factors for renal dysfunction.
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