title: Changes in renal function in long-term survivors of allogeneic hematopoietic stem-cell transplantation: single-center experience.
abstract: BACKGROUND
  Renal dysfunction after allogeneic hematopoietic stem cell transplantation (HSCT) has been increasingly reported. However, there are few reports on the changes of the estimated glomerular filtration rate (eGFR) in long-term survivors after allogeneic HSCT.
  
  
  METHODS
  The medical records at Seoul St. Mary's Hospital in Korea were reviewed to identify all adult (> 18-years-of-age) patients who had undergone high-dose chemotherapy and allogeneic HSCT between January 2001 and December 2005. Among these patients, those with < 5 years of follow-up and relapse within 5 years after HSCT were excluded. 85 patients were enrolled.
  
  
  RESULTS
  The mean follow-up was 76.0 ± 13.5 months. The eGFR recorded 3 months after HSCT was significantly decreased compared with the eGFR recorded before HSCT. Subsequently, early decreased eGFR was maintained during the 60 months after HSCT. Multivariate analysis showed that acute kidney injury (AKI) during HSCT, hypertension (HTN) and eGFR before HSCT was differently associated with changes in eGFR. The eGFR in patients who had AKI decreased significantly at 3 months after HSCT. After 3 months, the eGFR recovered to reach a lower level than in patients without AKI. The level was maintained during the 60 months after HSCT. The eGFR in patients who had low eGFR before HSCT (< 90 ml/min) decreased significantly at 3 months after HSCT, which was also maintained during the 60 months after HSCT. The eGFR in patients who had HTN also decreased significantly at 3 months after HSCT. By contrast, the eGFR decreased consistently and slowly from 3 to 60 months.
  
  
  CONCLUSIONS
  AKI and low baseline eGFR are associated with early renal dysfunction in patients after HSCT, but are not closely associated with long-term decline in eGFR. In contrast, eGFR in patients with HTN continuously decrease after 3 months of HSCT. Therefore, HTN seems to play a major role in the long-term decline in eGFR. These findings suggest that eGFR at 3 months after HSCT should be monitored closely for all patients who have undergone HSCT. Additionally, long-term follow-up of renal function is needed to prevent further renal damage for patients with HTN.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, The Yeungnam University of Korea, Seoul, Korea.
authors.forename: Seok Hui
authors.initials: SH
authors.lastname: Kang
authors.forename: Hoon Suk
authors.initials: HS
authors.lastname: Park
authors.forename: In O
authors.initials: IO
authors.lastname: Sun
authors.forename: Sun Ryoung
authors.initials: SR
authors.lastname: Choi
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Do
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Yoon
authors.forename: Cheol Whee
authors.initials: CW
authors.lastname: Park
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome