Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 6, Issue 1, Pages 89-94Publisher
WILEY
DOI: 10.1111/j.1600-6143.2005.01131.x
Keywords
acute renal failure; anemia; bone marrow transplant; cyclosporine; hypertension
Categories
Funding
- NCI NIH HHS [CA78902, CA18029, CA15704, K23 CA92058, P01 CA078902] Funding Source: Medline
- NHLBI NIH HHS [HL36444] Funding Source: Medline
- NIDDK NIH HHS [K23DK064689-01] Funding Source: Medline
- NATIONAL CANCER INSTITUTE [P01CA018029, P01CA078902, K23CA092058, P30CA015704] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [P01HL036444] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [K23DK064689] Funding Source: NIH RePORTER
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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.
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