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

Bone Marrow Transplantation volume 58, pages 1112–1120 (2023)Cite this article

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Abstract

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.

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Fig. 1: Distribution of the eGFR values.
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Data may be provided upon request to corresponding author.

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Acknowledgements

The authors would like to thank all patients and their families for participating in the NIH cGVHD natural history study. This work was supported by the Intramural Research Program of the National Institutes of Health, Center for Cancer Research, National Cancer Institute; the National Institute for Dental and Craniofacial Research; the National Institute of Arthritis and Musculoskeletal and Skin Diseases; and the National Eye Institute. The views expressed in this work do not represent the official views of the National Institutes of Health or the United States Government.

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Authors and Affiliations

  1. Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA

    David Beshensky, Filip Pirsl, Noa G. Holtzman, Eduard Schulz & Steven Z. Pavletic

  2. Biostatistics and Data Management Section, NCI, NIH, Bethesda, MD, USA

    Seth M. Steinberg

  3. Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA

    Jacqueline W. Mays

  4. Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD, USA

    Edward W. Cowen

  5. Department of Rehabilitation Medicine, NIH Clinical Center, Bethesda, MD, USA

    Leora E. Comis & Galen O. Joe

  6. Consult Services Section, National Eye Institute, National Institutes of Health, Bethesda, MD, USA

    M. Teresa Magone

  7. Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA

    Meryl A. Waldman

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Contributions

Concept of study: SZP, NGH, MAW, DB, and FP; data collection: SZP, NGH, MAW, JWM, EWC, LEC, GOJ, and MTM; data analysis: SMS, DB, and FP; draft, review, approval of manuscript: all authors.

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Correspondence to Steven Z. Pavletic.

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Beshensky, D., Pirsl, F., Holtzman, N.G. et al. Predictors and significance of kidney dysfunction in patients with chronic graft-versus-host disease. Bone Marrow Transplant 58, 1112–1120 (2023). https://doi.org/10.1038/s41409-023-02032-1

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