Chronic Kidney Disease in Pediatric Recipients of Hematopoietic Stem Cell Transplantation in a 5-Year Observation-A Single Center Experience.

Background: Chronic kidney disease (CKD) is a common complication of hematopoietic stem cell transplantation (HSCT). However, the data on its risk factors in the pediatric population is conflicting.

Methods: We retrospectively analyzed data from HSCT patients treated between 2005 and 2019, including indications for HSCT, conditioning regimens, and complications observed during a 5-year follow-up period, and calculated estimated glomerular filtration rate (eGFR) values. We used repeated measures ANOVA to model the time course of eGFR as a function of CKD. We built unadjusted and multiple adjusted logistic regression models. We did Kaplan-Meier plots and Cox regression with CKD as a potential risk factor for mortality.

Results: At HSCT, the median age (q5-q95) of the 200 (33.5% female) patients was 8.3 (0.64-17.4) years, median creatinine was 33.8 (17.0-65.5) μmol/L, 49 (24.5%) developed CKD, and 42 (21.0%) died during follow-up. In the unadjusted logistic regression model, CKD was negatively related to baseline eGFR (unadjusted OR per 10 mL/min/1.73 m² greater eGFR: 0.87, 95% CI 0.78-0.95; p = 0.004). In the stepwise selection model, greater AKI severity (OR 2.92, 95% CI 1.89-4.15; p < 0.0001), presence of hypertension (OR 2.68, 95% CI 1.02-7.05; p = 0.05), malnutrition (OR 5.42, 95% CI 1.98-14.82; p = 0.001), and iron overload (OR 3.88, 95% CI 1.31-11.51; p = 0.01) were related to CKD during follow-up. Female sex was protective (OR 0.19, 95% CI 0.06-0.61; p = 0.005). CKD status during follow-up was not related to the risk of mortality.

Conclusion: Our results underline the need for better nutrition, prevention of iron overload, and adequate blood pressure control to prevent CKD in pediatric patients after HSCT.