1. ¹Departments of Pediatrics, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
2. ²Department of Clinical Research and Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

Correspondence: Dr S Hingorani, Departments of Pediatrics and Medicine, Children's Hospital and Regional Medical Center, University of Washington, 4800 Sandpoint Way NE, M 1-5, Seattle, WA 98105, USA. E-mail: sangeeta.hingorani@seattlechildrens.org

Received 25 September 2006; Revised 27 November 2006; Accepted 28 November 2006.

Abstract

We conducted a cohort study to identify risk factors of chronic kidney disease (CKD) among long-term survivors of hematopoietic cell transplant (HCT). We studied 1635 patients transplanted at the Fred Hutchinson Cancer Research Center (FHCRC) between 1991 and 2002, who survived to day +131 after transplant and had serum creatinine measured on at least two occasions after day +131. CKD was defined as a glomerular filtration rate < 60 ml/min/m² on two occasions separated by at least 30 days between days 100 and 540 post transplant. Cox regression models estimated hazard ratios (HRs) describing associations between demographic data, clinical variables and the risk of developing CKD. A total of 376 patients (23%) developed CKD at a median of 191 days post transplant (range 131–516 days). An increased risk of CKD was associated with acute renal failure (ARF) (HR=1.7, 95% confidence interval (CI) 1.3–2.1), acute graft-vs-host disease (aGVHD) grade II (HR=2.0, 95% CI 1.4–2.9) and grades III/IV (HR=3.1, 95% CI 2.1–4.6) and chronic GVHD (HR=1.8, 95% CI 1.4–2.2). Total body irradiation (TBI) (HR=1.0, 95% CI 0.8–1.3) was not associated with an increased risk of CKD. CKD is relatively common among survivors of HCT. The presence of ARF and GVHD, but not receipt of TBI, appears to be associated with the occurrence of CKD.