Chronic kidney disease following non-myeloablative hematopoietic cell transplantation

Am J Transplant. 2006 Jan;6(1):89-94. doi: 10.1111/j.1600-6143.2005.01131.x.

Abstract

Chronic kidney disease (CKD) following myeloablative allogeneic hematopoietic cell transplantation (HCT) occurs in 20% of survivors at 1 year and is believed to be due to radiation nephritis. Non-myeloablative allogeneic HCT is a recent procedure that employs significantly lower doses of chemoradiotherapy, however, incidence and risk factors for CKD following non-myleoablative HCT have not been defined. We performed a retrospective cohort study of 122 patients from three institutions who were available for analysis at 6 months following non-myeloablative HCT. Patients received two Gy of radiation; 62% received fludarabine as preconditioning. CKD was defined as at least a 25% reduction in glomerular filtration rate (GFR) from baseline using the abbreviated modified diet in renal disease (MDRD) equation. Eighty-one of 122 patients (66%) showed evidence of CKD at follow-up. Multivariate analysis revealed that acute renal failure (ARF) during the first 100 days post-transplant was associated with development of CKD (Adjusted OR 32.8 with 95% CI 4.3-250) after controlling for other variables. Previous autologous HCT, long-term calcineurin inhibitor use and extensive chronic GVHD were independently associated with CKD. CKD following non-myeloablative HCT appears to be a distinct clinical entity and likely not related to radiation nephritis. Future research should focus on possible mechanisms for alleviating chronic injury and decreasing use of calcineurin inhibitors.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Calcineurin Inhibitors
  • Cohort Studies
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Hypertension, Renal / epidemiology
  • Hypertension, Renal / etiology
  • Incidence
  • Kidney / radiation effects
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / etiology*
  • Male
  • Middle Aged

Substances

  • Calcineurin Inhibitors