• View in gallery
    Figure 1

    The interrelationship of patient-related and disease-related risk factors causing AKI and CKD in HSCT patients

  • 1.

    Cockwell P, Fisher L-A. The global burden of chronic kidney disease. Lancet 2020; 395:662664. doi: 10.1016/S0140-6736(19)32977-0

  • 2.

    Hingorani S, et al. Urinary cytokines after HCT: Evidence for renal inflammation in the pathogenesis of proteinuria and kidney disease. Bone Marrow Transplant 2014; 49:403409. doi: 10.1038/bmt.2013.197

    • Search Google Scholar
    • Export Citation
  • 3.

    Zhou W, et al. Long-term renal outcome after allogeneic hemopoietic stem cell transplant: A comprehensive analysis of risk factors in an Asian patient population. Clin Transplant 2017; 31:e12920. doi: 10.1111/ctr.12920

    • Search Google Scholar
    • Export Citation
  • 4.

    Weiss AS, et al. Chronic kidney disease following non-myeloablative hematopoietic cell transplantation. Am J Transplant 2006; 6:8994. doi: 10.1111/j.1600-6143.2005.01131.x

    • Search Google Scholar
    • Export Citation
  • 5.

    Saddadi F, et al. Chronic kidney disease after hematopoietic cell transplantation: Frequency, risk factors, and outcomes. Transplant Proc 2009; 41:28952897. doi: 10.1016/j.transproceed.2009.07.093

    • Search Google Scholar
    • Export Citation
  • 6.

    Pelletier K, et al. Chronic kidney disease, survival and graft-versus-host-disease/relapse-free survival in recipients of allogeneic hematopoetic stem cell transplant. Clin Kidney J [published online April 7, 2022]. https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfac091/6564752?login=false

    • Search Google Scholar
    • Export Citation
  • 7.

    Ellis MJ, et al. Chronic kidney disease after hematopoietic cell transplantation: A systematic review. Am J Transplant 2008; 8:23782390. doi: 10.1111/j.1600-6143.2008.02408.x

    • Search Google Scholar
    • Export Citation
  • 8.

    Ando M, et al. Chronic kidney disease in long-term survivors of myeloablative allogeneic haematopoietic cell transplantation: Prevalence and risk factors. Nephrol Dial Transplant 2010; 25:278282. doi: 10.1093/ndt/gfp485

    • Search Google Scholar
    • Export Citation
  • 9.

    Abramson MH, et al. Acute kidney injury in the modern era of allogeneic hematopoietic stem cell transplantation. Clin J Am Soc Nephrol 2021; 16:13181327. doi: 10.2215/CJN.19801220

    • Search Google Scholar
    • Export Citation
  • 10.

    Jo T, et al. Chronic kidney disease in long-term survivors after allogeneic hematopoietic stem cell transplantation: Retrospective analysis at a single institute. Biol Blood Marrow Transplant 2017; 23:21592165. doi: 10.1016/j.bbmt.2017.08.016

    • Search Google Scholar
    • Export Citation
  • 11.

    Touzot M, et al. Long-term renal function after allogenic haematopoietic stem cell transplantation in adult patients: A single-centre study. Nephrol Dial Transplant 2010; 25:624627. doi: 10.1093/ndt/gfp529

    • Search Google Scholar
    • Export Citation
  • 12.

    Hingorani S, et al. Changes in glomerular filtration rate and impact on long-term survival among adults after hematopoietic cell transplantation: A prospective cohort study. Clin J Am Soc Nephrol 2018; 13:866873. doi: 10.2215/CJN.10630917

    • Search Google Scholar
    • Export Citation
  • 13.

    Sedhom R, et al. Mini-review of kidney disease following hematopoietic stem cell transplant. Clin Nephrol 2018; 89:389402. doi: 10.5414/CN109276

    • Search Google Scholar
    • Export Citation
  • 14.

    Osugi Y, et al. Treatment with candesartan combined with angiotensin-converting enzyme inhibitor for immunosuppressive treatment-resistant nephrotic syndrome after allogeneic stem cell transplantation. Int J Hematol 2006; 83:454458. doi: 10.1532/IJH97.05183

    • Search Google Scholar
    • Export Citation
  • 15.

    Abboud I, et al. Chronic kidney diseases in long-term survivors after allogeneic hematopoietic stem cell transplantation: Monitoring and management guidelines. Semin Hematol 2012; 49:7382. doi: 10.1053/j.seminhematol.2011.10.008

    • Search Google Scholar
    • Export Citation

Improving Our Understanding of Long-Term Kidney Outcomes after Allogeneic Stem Cell Transplant

Matthew AbramsonMatthew Abramson, MD, and Priya Deshpande, MD, are with the Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY.

Search for other papers by Matthew Abramson in
Current site
Google Scholar
PubMed
Close
and
Priya DeshpandeMatthew Abramson, MD, and Priya Deshpande, MD, are with the Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY.

Search for other papers by Priya Deshpande in
Current site
Google Scholar
PubMed
Close
Full access

Although allogeneic hematopoietic stem cell transplant (HSCT) is the curative treatment for many patients with hematologic conditions, these patients are at a higher risk of acute kidney injury (AKI) and chronic kidney disease (CKD) as a result of conditioning therapies, exposure to radiation therapy, and chronic treatment with calcineurin inhibitors (Figure 1). CKD and albuminuria increase the risk of hypertension and end stage kidney disease, which ultimately impact mortality (1, 2). Many studies have evaluated the incidence of CKD post-HSCT, and the incidence of CKD ranges from 4% to 66% (39). However, some studies have yielded conflicting results regarding overall mortality in patients who develop CKD after HSCT (1012). In a recent article in the Clinical Kidney Journal, Pelletier et al. (6) sought to determine the prevalence and risk factors for developing CKD and assess the impact of CKD on 1-year overall survival, relapse-free survival (RFS), transplant-related mortality (TRM), relapse risk, and graft-versus-host disease (GVHD)-free/RFS (GRFS) in a retrospective single-center analysis of 408 adults with hematologic malignancies who underwent HSCT in Toronto, Ontario, Canada.

Figure 1
Figure 1

The interrelationship of patient-related and disease-related risk factors causing AKI and CKD in HSCT patients

Citation: Kidney News 14, 7

AML, angiomyolipoma; CNI, calcineurin inhibitor; FSGS, focal segmental glomerulosclerosis; HSOS, hepatic sinusoidal obstruction syndrome; MPGN, membranoproliferative glomerulonephritis.

Pelletier et al. (6) found that 64% of patients developed AKI (defined and staged based on the Kidney Disease Improving Global Outcomes) at 100 days post-HSCT. Nine percent of patients developed CKD (defined using the CKD-Epidemiology Collaboration equation by an estimated glomerular filtration rate of <60 mL/min/1.73 m2) 100 days post-HSCT. Nineteen percent of patients developed CKD 1 year post-HSCT. Patients who developed CKD at 1 year experienced AKI within 100 days of transplant, were older, and were female. The patients who developed CKD after 1 year had a twofold increase in mortality as compared with patients who did not, even after adjustment for covariates. CKD at 1 year was associated with worse GRFS but had no effect on RFS, TRM, and relapse risk.

This study highlights the need for a multidisciplinary approach between the oncology and nephrology teams to care for HSCT patients, particularly those who are at higher risk for developing CKD. In the right clinical context, these patients may benefit from renin-angiotensin aldosterone system blockade (1315).

References

  • 1.

    Cockwell P, Fisher L-A. The global burden of chronic kidney disease. Lancet 2020; 395:662664. doi: 10.1016/S0140-6736(19)32977-0

  • 2.

    Hingorani S, et al. Urinary cytokines after HCT: Evidence for renal inflammation in the pathogenesis of proteinuria and kidney disease. Bone Marrow Transplant 2014; 49:403409. doi: 10.1038/bmt.2013.197

    • Search Google Scholar
    • Export Citation
  • 3.

    Zhou W, et al. Long-term renal outcome after allogeneic hemopoietic stem cell transplant: A comprehensive analysis of risk factors in an Asian patient population. Clin Transplant 2017; 31:e12920. doi: 10.1111/ctr.12920

    • Search Google Scholar
    • Export Citation
  • 4.

    Weiss AS, et al. Chronic kidney disease following non-myeloablative hematopoietic cell transplantation. Am J Transplant 2006; 6:8994. doi: 10.1111/j.1600-6143.2005.01131.x

    • Search Google Scholar
    • Export Citation
  • 5.

    Saddadi F, et al. Chronic kidney disease after hematopoietic cell transplantation: Frequency, risk factors, and outcomes. Transplant Proc 2009; 41:28952897. doi: 10.1016/j.transproceed.2009.07.093

    • Search Google Scholar
    • Export Citation
  • 6.

    Pelletier K, et al. Chronic kidney disease, survival and graft-versus-host-disease/relapse-free survival in recipients of allogeneic hematopoetic stem cell transplant. Clin Kidney J [published online April 7, 2022]. https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfac091/6564752?login=false

    • Search Google Scholar
    • Export Citation
  • 7.

    Ellis MJ, et al. Chronic kidney disease after hematopoietic cell transplantation: A systematic review. Am J Transplant 2008; 8:23782390. doi: 10.1111/j.1600-6143.2008.02408.x

    • Search Google Scholar
    • Export Citation
  • 8.

    Ando M, et al. Chronic kidney disease in long-term survivors of myeloablative allogeneic haematopoietic cell transplantation: Prevalence and risk factors. Nephrol Dial Transplant 2010; 25:278282. doi: 10.1093/ndt/gfp485

    • Search Google Scholar
    • Export Citation
  • 9.

    Abramson MH, et al. Acute kidney injury in the modern era of allogeneic hematopoietic stem cell transplantation. Clin J Am Soc Nephrol 2021; 16:13181327. doi: 10.2215/CJN.19801220

    • Search Google Scholar
    • Export Citation
  • 10.

    Jo T, et al. Chronic kidney disease in long-term survivors after allogeneic hematopoietic stem cell transplantation: Retrospective analysis at a single institute. Biol Blood Marrow Transplant 2017; 23:21592165. doi: 10.1016/j.bbmt.2017.08.016

    • Search Google Scholar
    • Export Citation
  • 11.

    Touzot M, et al. Long-term renal function after allogenic haematopoietic stem cell transplantation in adult patients: A single-centre study. Nephrol Dial Transplant 2010; 25:624627. doi: 10.1093/ndt/gfp529

    • Search Google Scholar
    • Export Citation
  • 12.

    Hingorani S, et al. Changes in glomerular filtration rate and impact on long-term survival among adults after hematopoietic cell transplantation: A prospective cohort study. Clin J Am Soc Nephrol 2018; 13:866873. doi: 10.2215/CJN.10630917

    • Search Google Scholar
    • Export Citation
  • 13.

    Sedhom R, et al. Mini-review of kidney disease following hematopoietic stem cell transplant. Clin Nephrol 2018; 89:389402. doi: 10.5414/CN109276

    • Search Google Scholar
    • Export Citation
  • 14.

    Osugi Y, et al. Treatment with candesartan combined with angiotensin-converting enzyme inhibitor for immunosuppressive treatment-resistant nephrotic syndrome after allogeneic stem cell transplantation. Int J Hematol 2006; 83:454458. doi: 10.1532/IJH97.05183

    • Search Google Scholar
    • Export Citation
  • 15.

    Abboud I, et al. Chronic kidney diseases in long-term survivors after allogeneic hematopoietic stem cell transplantation: Monitoring and management guidelines. Semin Hematol 2012; 49:7382. doi: 10.1053/j.seminhematol.2011.10.008

    • Search Google Scholar
    • Export Citation
Save