Changes in renal function in long-term survivors of allogeneic hematopoietic stem-cell transplantation: single-center experience

Title
Changes in renal function in long-term survivors of allogeneic hematopoietic stem-cell transplantation: single-center experience
Author(s)
도준영강석휘[강석휘]박훈석[박훈석]선인오[선인오]최선영[최선영]정병하[정병하]최범순[최범순]민창기[민창기]양철우[양철우]김용수[김용수]윤경우박철휘[박철휘]
Keywords
CHRONIC KIDNEY-DISEASE; PREDICTORS
Issue Date
201203
Publisher
DUSTRI-VERLAG DR KARL FEISTLE
Citation
CLINICAL NEPHROLOGY, v.77, no.3, pp.225 - 230
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. Patients and 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. Conclusion: 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.
URI
http://hdl.handle.net/YU.REPOSITORY/29616http://dx.doi.org/10.5414/CN107280
ISSN
0301-0430
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의과대학 > 내과학교실 > Articles
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