Mini-review of kidney disease following hematopoietic stem cell transplant
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Advancements in hematopoietic cell transplantation (HCT) have broadened indications for its use and resulted in more long-term survivors. Stem cell transplantation is associated with several well-known toxicities, although renal complications are not well defined. Acute and chronic kidney disease remains a common complication following transplantation itself. Incidence and risk factors for the development of chronic kidney disease (CKD) is less well understood. Recent estimates suggest that nearly 15% of subjects undergoing HCT will develop CKD, a complication that can progress to end-stage renal disease (ESRD), disrupts overall quality of life, and reduces overall survival. Several commonly-reported risk factors include acute kidney injury, graft-versus-host disease, and long-term calcineurin inhibitor use. This review highlights the incidence, timeline, etiology, risk factors, and prognosis of kidney disease in the setting of hematopoietic stem cell transplantation. Investigation of the causes of CKD is needed, as are ways to prevent, mitigate, and treat kidney injury. Renal disease importantly reflects prognosis, with dialysis-requiring patients carrying greater than 80% mortality after 3 years. Although CKD following HCT is common, prospective studies are needed to confirm risk factors and better define the underlying mechanisms in order to promote therapies that prevent this complication.
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