Renal dysfunction in allogeneic hematopoietic cell transplantation.
BACKGROUND
Allogeneic hematopoietic cell transplantation (HCT), formerly called bone marrow transplantation, can potentially cure various malignant and non-malignant diseases, but it is associated with a high risk of toxicity. We have previously shown an overall 21% incidence of severe acute renal failure in patients undergoing autologous HCT. The present study evaluated renal dysfunction in patients undergoing allogeneic HCT.


METHODS
The clinical course of 88 adult patients who received allogeneic HCT at the University of Colorado Health Science Center was analyzed. Renal dysfunction was classified as follows: Grade 0 = normal renal function; Grade 1 =>25% decrement in GFR but <twofold rise in serum creatinine; Grade 2 =>twofold increase in serum creatinine; Grade 3 =>twofold increase in serum creatinine and need for dialysis.


RESULTS
Of the 88 patients, 81 (92%) patients had some degree of renal dysfunction (Grade 1, 20 patients; Grade 2, 32 patients; Grade 3, 29 patients). Severe nephrotoxicity (Grade 2 and Grade 3 renal dysfunction) was associated with significantly higher frequencies of sepsis, hepatic toxicity and hepatic veno-occlusive disease (VOD), and lung toxicity. The overall mortality rate at the end of 6 months was 58%. Grade 3 renal dysfunction was associated with a significantly increased risk of mortality (82.6%).


CONCLUSIONS
A 92% incidence of renal dysfunction in allogeneic HCT patients was found. Lung and liver toxicities were significantly correlated with developing renal dysfunction, and the mortality rates for patients with Grade 3 renal failure exceeded 80%.
Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA.
Chirag R
CR
Parikh
Peter A
PA
McSweeney
Didem
D
Korular
Tevfik
T
Ecder
Aicha
A
Merouani
Jeremy
J
Taylor
Vicki
V
Slat-Vasquez
Elizabeth J
EJ
Shpall
Roy B
RB
Jones
Scott I
SI
Bearman
Robert W
RW
Schrier
D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006400:Hematocrit; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality*; D006454:Hemoglobins; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007674:Kidney Diseases / Q000401:mortality*; D008107:Liver Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000401:mortality; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous
D006454:Hemoglobins; D007166:Immunosuppressive Agents; D016572:Cyclosporine