Chronic kidney disease after hematopoietic cell transplantation: a systematic review

Abstract

Advances in hematopoietic cell transplantation (HCT) have broadened its indications for use and resulted in more long-term HCT survivors. Some survivors develop chronic kidney disease (CKD); however, the incidence and risk factors are unclear. We performed a systematic review of studies identified from databases (MEDLINE, EMBASE, Science Citation Index), conference abstracts and reference lists from selected manuscripts. From 927 manuscripts, 28 patient cohorts were identified in which 9317 adults and children underwent HCT and 7317 (79%) survived to at least 100 days, permitting inclusion of 5337 (73% of survivors) in quantitative analyses. Although definitions and measurements varied widely, approximately 16.6% of HCT patients developed CKD and estimated glomerular filtration rate (eGFR in mL/min/1.73 m(2)) decreased by 24.5 after 24 months. This decrease was greater amongst patients undergoing allogeneic HCT (DeltaeGFR = -40.0 versus -18.6 for autologous transplants). Several commonly reported risk factors for CKD were investigated, including acute renal failure, total body irradiation, graft versus host disease and long-term cyclosporine use. In conclusion, CKD following HCT is likely to be common; however, prospective studies with uniform definitions of CKD and risk factors are needed to confirm these findings and better define the underlying mechanisms to promote therapies that prevent this complication.

Figure 1. Summary of manuscript inclusion and exclusion for systematic review and meta-analysis

927 manuscripts were initially identified through data base searches, abstract and bibliographic review; 28 cohorts of patients met all inclusion criteria.

Figure 2. Odds ratios (95% CI) for CKD following HCT, according to four commonly reported risk-factors (■)

The size of each square is inversely proportion to variability of the study estimate. (A) Acute renal failure (ARF); I² = 70.4. (B) Long-term (greater than 60 days) use of cyclosporine (CsA); I² = 82.9. (C) Development of chronic graft versus host disease (cGvHD); although the pooled estimate appears statistically significant, the high degree of heterogeneity makes the pooled estimate invalid (I² = 52.4). (D) Exposure to greater than 11 gray of total body irradiation (TBI); I² = 74.1.

Figure 2. Odds ratios (95% CI) for CKD following HCT, according to four commonly reported risk-factors (■)

The size of each square is inversely proportion to variability of the study estimate. (A) Acute renal failure (ARF); I² = 70.4. (B) Long-term (greater than 60 days) use of cyclosporine (CsA); I² = 82.9. (C) Development of chronic graft versus host disease (cGvHD); although the pooled estimate appears statistically significant, the high degree of heterogeneity makes the pooled estimate invalid (I² = 52.4). (D) Exposure to greater than 11 gray of total body irradiation (TBI); I² = 74.1.

Figure 2. Odds ratios (95% CI) for CKD following HCT, according to four commonly reported risk-factors (■)

The size of each square is inversely proportion to variability of the study estimate. (A) Acute renal failure (ARF); I² = 70.4. (B) Long-term (greater than 60 days) use of cyclosporine (CsA); I² = 82.9. (C) Development of chronic graft versus host disease (cGvHD); although the pooled estimate appears statistically significant, the high degree of heterogeneity makes the pooled estimate invalid (I² = 52.4). (D) Exposure to greater than 11 gray of total body irradiation (TBI); I² = 74.1.

Figure 2. Odds ratios (95% CI) for CKD following HCT, according to four commonly reported risk-factors (■)

The size of each square is inversely proportion to variability of the study estimate. (A) Acute renal failure (ARF); I² = 70.4. (B) Long-term (greater than 60 days) use of cyclosporine (CsA); I² = 82.9. (C) Development of chronic graft versus host disease (cGvHD); although the pooled estimate appears statistically significant, the high degree of heterogeneity makes the pooled estimate invalid (I² = 52.4). (D) Exposure to greater than 11 gray of total body irradiation (TBI); I² = 74.1.