Impact of Tyrosine Kinase Inhibitors on Estimated Glomerular Filtration Rate in Chronic Myeloid Leukemia Patients

Introduction: Tyrosine kinase inhibitors (TKIs) are the cornerstone of therapy for chronic myeloid leukemia (CML). Although nephrotoxicity has been reported, existing evidence remains inconsistent, with limited data from the Gulf region. This study aimed to evaluate the impact of TKIs on renal function among patients with CML treated at Hamad Medical Corporation (HMC), Qatar.

This retrospective, single-center study included adults with CML who received a TKI between 2016 and 2023. The primary outcome was the change in estimated glomerular filtration rate (eGFR) over time. Secondary outcomes included acute kidney injury (AKI), chronic kidney disease (CKD) and the need for dialysis. Repeated-measures analysis of variance was used to assess unadjusted eGFR trends. Linear mixed-effects modeling was used to assess longitudinal eGFR trends while adjusting for baseline comorbidities.

A total of 209 patients were followed for a median of 69.3 months (IQR, 39.4-117.8). Imatinib was the most frequently prescribed TKI (n = 136, 65.1%), followed by dasatinib (n = 39, 18.7%) and nilotinib (n = 34, 16.3%). The mean baseline eGFR was 93.8 mL/min/1.73 m2 (SD 26.3) and showed no significant decline at 3 months (p = 0.498), 3 years (p = 0.112), or 8 years (p = 0.297). However, among dasatinib-treated patients, eGFR significantly decreased from 87.5 (SD 16.7) to 76.8 (SD 11.4) over 3 years (p = 0.042). Multivariate mixed-effects modeling revealed that this reduction was confounded by hypertension (p < 0.001). After adjusting for comorbidities, no significant difference in eGFR decline was observed between the TKI groups. AKI occurred in 17 (8.1%) patients, CKD in 4 (1.9%), and none required dialysis. No significant differences were observed across TKI types.

Renal function remained largely stable during long-term TKI therapy. Initial declines to dasatinib were largely comorbidity-driven, pointing to the need for cardiovascular risk assessment in this population.