Long-term Renal Function After Stem Cell Transplantation in Adults
Long-term Renal Function After Stem Cell Transplantation in Adults
Background. Reported data regarding chronic kidney disease (CKD) in haematopoietic stem cells transplantation (HSCT) recipients are highly discrepant.
Materials and methods. We undertook a retrospective single-centre study in order to assess the rate, risk factors and outcome of HSCT-associated CKD in 123 allogeneic HSCT patients.
Results. Twenty-four months after HSCT, CKD [e.g. glomerular filtration rate (GFR) estimated using the MDRD formula < 60 ml/min/1.73 m] was noted in 49 patients (40%). Age ≥ 45 years, early acute kidney injury and a baseline GFR < 90 ml/min/1.73 m predicted the occurrence of CKD at 24 months after HSCT. One hundred and six patients (45 with and 61 without CKD at 24 months) were followed up for more than 36 months (range 36–142). Among the 45 patients with CKD at 24 months after HSCT, CKD persisted in 30 (67%), 10 patients (22%) showed a transient improvement in GFR but retained CKD and 10 patients (22%) had a sustained improvement of GFR. Among 61 patients without CKD at 24 months after HSCT, 3 (5%) developed CKD during the follow-up. Our data indicate that HSCT-related CKD probably includes two subsets: a frequent early-onset CKD, a consequence of ARF in older patients with pre-existent renal impairment, and a rare late-onset CKD occurring more than 2 years following HSCT.
Conclusions. Careful monitoring of renal function is mandatory in patients undergoing HSCT, especially old patients with pre-existent renal impairment.
Haematopoietic stem cell transplantation (HSCT) is an established and increasingly used treatment for a wild range of haematological malignancies. Improved supportive care and transplantation procedures have translated into a dramatic improvement of overall survival of patients undergoing HSCT. However, long-term organ damage has emerged as an increasingly identified cause of morbidity and mortality in patients who have undergone HSCT.
In the last decade, chronic kidney disease (CKD) arising after HSCT has been increasingly reported. However, published studies have yielded discrepant results with an incidence of HSCT-related CKD ranging from 4 to 66% of patients.
We undertook a retrospective single-centre study in order to assess the rate, risk factors and outcome of HSCT-associated CKD in long-term (>2 years) survivors of a cohort of allogeneic HSCT patients.
This retrospective study was undertaken in the Departments of Nephrology and Haematology in Hôpital Necker, Paris, France. Using a computerized database, we identified all adult (>18 years) patients who had undergone an allogeneic HSCT between January 1995 and December 2005. Patients who had survived more than 2 years after HSCT were included in the study. Patient's medical records were reviewed and relevant data collected.
CKD was defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m noted on at least two occasions at ±3 months from the 24-month follow-up time point. GFR was estimated using the Modification of Diet in Renal Disease (MDRD) study simplified equation.
Acute kidney injury (AKI) occurring within the 100 first days after HSCT was evaluated according to the RIFLE criteria.
Hypertension was defined by a systolic blood pressure >140 mmHg and/or a diastolic blood pressure >90 mmHg and/or the need for antihypertensive drugs.
Abstract and Introduction
Abstract
Background. Reported data regarding chronic kidney disease (CKD) in haematopoietic stem cells transplantation (HSCT) recipients are highly discrepant.
Materials and methods. We undertook a retrospective single-centre study in order to assess the rate, risk factors and outcome of HSCT-associated CKD in 123 allogeneic HSCT patients.
Results. Twenty-four months after HSCT, CKD [e.g. glomerular filtration rate (GFR) estimated using the MDRD formula < 60 ml/min/1.73 m] was noted in 49 patients (40%). Age ≥ 45 years, early acute kidney injury and a baseline GFR < 90 ml/min/1.73 m predicted the occurrence of CKD at 24 months after HSCT. One hundred and six patients (45 with and 61 without CKD at 24 months) were followed up for more than 36 months (range 36–142). Among the 45 patients with CKD at 24 months after HSCT, CKD persisted in 30 (67%), 10 patients (22%) showed a transient improvement in GFR but retained CKD and 10 patients (22%) had a sustained improvement of GFR. Among 61 patients without CKD at 24 months after HSCT, 3 (5%) developed CKD during the follow-up. Our data indicate that HSCT-related CKD probably includes two subsets: a frequent early-onset CKD, a consequence of ARF in older patients with pre-existent renal impairment, and a rare late-onset CKD occurring more than 2 years following HSCT.
Conclusions. Careful monitoring of renal function is mandatory in patients undergoing HSCT, especially old patients with pre-existent renal impairment.
Introduction
Haematopoietic stem cell transplantation (HSCT) is an established and increasingly used treatment for a wild range of haematological malignancies. Improved supportive care and transplantation procedures have translated into a dramatic improvement of overall survival of patients undergoing HSCT. However, long-term organ damage has emerged as an increasingly identified cause of morbidity and mortality in patients who have undergone HSCT.
In the last decade, chronic kidney disease (CKD) arising after HSCT has been increasingly reported. However, published studies have yielded discrepant results with an incidence of HSCT-related CKD ranging from 4 to 66% of patients.
We undertook a retrospective single-centre study in order to assess the rate, risk factors and outcome of HSCT-associated CKD in long-term (>2 years) survivors of a cohort of allogeneic HSCT patients.
Patients and Methods
This retrospective study was undertaken in the Departments of Nephrology and Haematology in Hôpital Necker, Paris, France. Using a computerized database, we identified all adult (>18 years) patients who had undergone an allogeneic HSCT between January 1995 and December 2005. Patients who had survived more than 2 years after HSCT were included in the study. Patient's medical records were reviewed and relevant data collected.
CKD was defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m noted on at least two occasions at ±3 months from the 24-month follow-up time point. GFR was estimated using the Modification of Diet in Renal Disease (MDRD) study simplified equation.
Acute kidney injury (AKI) occurring within the 100 first days after HSCT was evaluated according to the RIFLE criteria.
Hypertension was defined by a systolic blood pressure >140 mmHg and/or a diastolic blood pressure >90 mmHg and/or the need for antihypertensive drugs.
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