Chronic Kidney Disease after Nonmyeloablative Stem Cell Transplantation in Adults

Chronic kidney disease (CKD) after myeloablative stem cell transplantation (SCT) is a well-established problem. Little is known about CKD after nonmyeloablative SCT. We performed a retrospective cohort study of 108 adults who received nonmyeloablative SCT with fludarabine and/or total-body irradiation (TBT) conditioning. Renal function was assessed by estimating glomerular filtration rate (GFR) with the MDRD equation. CKD was defined as GFR <60 mL/min/1.73 m2. CKD developed in 15% of patients after a median of 15 months. None of the patients required dialysis. Cumulative incidence of CKD was 7% at 12 months, 14% at 24 months, and 22% at 48 months. Risk factors for CKD were female sex (P = .021), older age (P = .040), and lower GFR pretransplant (P < .001). Complications after SCT were not associated with CKD. SCT nephropathy, a cause of CKD after myeloablative SCT, did not occur. Overall survival (OS) was 66%. There was no difference in survival between patients with or without CKD. In conclusion, CKD is a frequent complication after nonmyeloablative SCT and is not related to SCT nephropathy. Women, patients above 50 years of age, and patients with slightly decreased kidney function pretransplant have the greatest risk of development of CKD.