Predictors and significance of kidney dysfunction in patients with chronic graft-versus-host disease

• Published in: Bone marrow transplantation (Basingstoke) Vol. 58; no. 10; pp. 1112 - 1120
• Main Authors: Beshensky, David, Pirsl, Filip, Holtzman, Noa G., Steinberg, Seth M., Mays, Jacqueline W., Cowen, Edward W., Comis, Leora E., Joe, Galen O., Magone, M. Teresa, Schulz, Eduard, Waldman, Meryl A., Pavletic, Steven Z.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2023; Nature Publishing Group
• Subjects: 692/499; 692/699/67/71; Angiotensin; Bone marrow; Bronchiolitis Obliterans Syndrome; Cell Biology; Chronic Disease; Complications; Cross-Sectional Studies; Cyclosporine - adverse effects; Cyclosporins; Epidermal growth factor receptors; Fascia; Graft versus host disease; Graft vs Host Disease - drug therapy; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Hemoglobin; Humans; Internal Medicine; Kidney; Kidney diseases; Kidney transplantation; Kidneys; Medicine; Medicine & Public Health; Prophylaxis; Proteinuria; Public Health; Stem cell transplantation; Stem Cells; Survival
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-023-02032-1

Kidney complications have been studied in allogeneic hematopoietic stem cell transplant patients but not specifically among chronic graft-versus-host disease (cGVHD) patients. Participants ( n  = 365) enrolled in the cross-sectional cGVHD natural history study (NCT00092235) were assessed for kidney dysfunction and overall survival. Kidney dysfunction was analyzed for associations in univariate and multivariable analyses. Kidney dysfunction (eGFR < 60) was found in 64 patients, and 29 patients had moderate-severe kidney dysfunction (eGFR < 45). Patients with kidney dysfunction were more likely treated with cyclosporine at evaluation or to have received it for GVHD prophylaxis, or prior treatment of GVHD. Patients with kidney dysfunction were less severely affected by cGVHD of skin, mouth, and joints/fascia. In multivariable modeling, history of cyclosporine use (OR = 2.19, 95% CI 1.13–4.25), angiotensin receptor blocker use (OR = 5.57, 95% CI 1.49–20.84), proteinuria (OR = 2.39, 95% CI 1.19–4.79), lower CRP (OR = 0.95, 95% CI 0.91–0.99), lower C3 (OR = 0.98, 95% CI 0.97–0.99), and lower hemoglobin (OR = 0.70, 95% CI 0.58–0.84) were jointly associated with kidney dysfunction. Overall survival was lower in those with moderate-severe kidney dysfunction ( p  = 0.015), demonstrating the importance of addressing kidney dysfunction in this population. The association of kidney dysfunction with less severe cGVHD suggests an etiology unrelated to cGVHD but potentially a consequence of drug-related toxicities.