Risk Factors for Acute Kidney Injury and Chronic Kidney Disease following Allogeneic Hematopoietic Stem Cell Transplantation for Hematopoietic Malignancies

Background:Acute kidney injury (AKI) and chronic kidney disease (CKD) are considered common complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Objectives and Method:In this study, 114 patients who had undergone allo-HSCT were retrospectively analyzed to investigate the risk factors for onset of posttransplant AKI and CKD as defined by the new Kidney Disease Improving Global Outcomes criteria.Results:Seventy-four patients (64.9%) developed AKI and 25 (21.9%) developed CKD. The multivariate analysis showed that the risk factors for developing stage 1 or higher AKI were age >= 46 years at the time of transplant (p= 0.001) and use of >= 3 nephrotoxic drugs (p= 0.036). For CKD, the associated risk factors were disease status other than complete remission at the time of transplantation (p= 0.018) and onset of AKI after transplant (p= 0.035). The 5-year overall survival (OS) was significantly reduced by development of AKI (p< 0.001), but not CKD. Posttransplant AKI significantly increased the 5-year nonrelapse mortality (p< 0.001), whereas posttransplant CKD showed an increasing tendency, but the difference was not significant.Conclusions:Posttransplant AKI impacts OS, significantly increases the risk of CKD, and is significantly associated with disseminated intravascular coagulation and use of >3 nephrotoxic drugs.