Chronic Kidney Disease Following Non‐Myeloablative Hematopoietic Cell Transplantation

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.