Twenty-eight cohorts reported in 26 publications (n=9,317 patients; 7,317 survived at least 100 days and 5,337 survived at least 100 days and had kidney function assessed) were included in the review. Many of the studies were retrospective and uncontrolled (number not reported). The number of assessed patients ranged from 17 to 1,635.
Risk of chronic kidney disease after allogeneic HCT was 27.8% in comparison with 25.2% after autologous HCT (difference 2.6%, p=0.40). When allogeneic and autologous HCT patients were combined, incidence of chronic kidney disease was 13.9% (difference 11% to 14%, p<0.0001) in comparison with autologous and allogeneic transplants alone. Pooled risk of chronic kidney disease for allogeneic versus autologous HCT showed no significant difference between the two groups of patients. Incidence of chronic kidney disease was higher for adults (30.2%) than children (18.2%); the incidence in mixed populations of adults and children was 14.3%.
Approximately 16.6% of HCT patients developed chronic kidney disease with a decrease in glomerular filtration rate of 24.5mL/min/1.73m2 after 24 months. The glomerular filtration rate decreased more moderately for allogeneic patients versus autologous patients (-40.0 versus -18.6mL/min/1.73m2). Data from further analyses were reported in the review.
Numerous risk factors associated with development of chronic kidney disease after HCT were reported in the studies. The most frequently reported factors were acute renal failure (four cohorts), long-term used of CsA (five cohorts), cGvHD (six cohorts) and cumulative dose of total body irradiation (seven cohorts). The pooled estimate for cGVHD as a risk factor was OR 1.75 (95% CI 1.08 to 2.84) with significant heterogeneity (I2>50%). All of the risk factor analyses showed significant heterogeneity. Three risk factors showed no significant associations with the development of chronic kidney disease after HCT.
Other outcomes included 7.8% of patients with proteinuria and 0.8% of patients with end-stage renal disease; hypertension was reported in 12.4% of patients.