Chronic kidney disease in long-term survivors of hematopoietic cell transplant
Chronic kidney disease in long-term survivors of hematopoietic cell transplant
复制标题
造血细胞移植长期存活者的慢性肾病
DOI：
10.1038/sj.bmt.1705573
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发表时间：
2007-02-01
影响因子：
4.8
通讯作者：
McDonald, G. B.
中科院分区：
文献类型：
--
作者：
Hingorani, S.;Guthrie, K. A.;McDonald, G. B.
我们进行了一项队列研究，以确定造血细胞移植 (HCT) 长期幸存者中慢性肾脏病 (CKD) 的危险因素。我们研究了 1991 年至 2002 年间在 Fred Hutchinson 癌症研究中心 (FHCRC) 进行移植的 1635 名患者，他们在移植后存活至第 +131 天，并且在第 +131 天后至少两次测量了血清肌酐。 CKD 的定义是移植后第 100 天至第 540 天之间间隔至少 30 天两次肾小球滤过率 < 60 ml/min/m(2)。 Cox 回归模型估计了描述人口数据、临床变量和 CKD 风险之间关联的风险比 (HR)。共有 376 名患者 (23%) 在移植后中位 191 天（范围 131-516 天）出现 CKD。 CKD 风险增加与急性肾衰竭 (ARF)（HR = 1.7，95% 置信区间 (CI) 1.3-2.1）、急性移植物抗宿主病 (aGVHD) II 级（HR = 2.0，95% CI 1.4-2.9）和 III/IV 级（HR = 3.1，95% CI 2.1-4.6）以及慢性 GVHD (HR = 1.8，95% CI 1.4-2.2）。全身照射 (TBI)（HR = 1.0，95% CI 0.8-1.3）与 CKD 风险增加无关。 CKD 在 HCT 幸存者中相对常见。 ARF 和 GVHD 的存在，但未发生 TBI，似乎与 CKD 的发生有关。
We conducted a cohort study to identify risk factors of chronic kidney disease (CKD) among long-term survivors of hematopoietic cell transplant (HCT). We studied 1635 patients transplanted at the Fred Hutchinson Cancer Research Center (FHCRC) between 1991 and 2002, who survived to day +131 after transplant and had serum creatinine measured on at least two occasions after day +131. CKD was defined as a glomerular filtration rate < 60 ml/min/m(2) on two occasions separated by at least 30 days between days 100 and 540 post transplant. Cox regression models estimated hazard ratios (HRs) describing associations between demographic data, clinical variables and the risk of developing CKD. A total of 376 patients (23%) developed CKD at a median of 191 days post transplant (range 131-516 days). An increased risk of CKD was associated with acute renal failure (ARF) (HR = 1.7, 95% confidence interval (CI) 1.3-2.1), acute graft-vs-host disease (aGVHD) grade II (HR = 2.0, 95% CI 1.4-2.9) and grades III/IV (HR = 3.1, 95% CI 2.1-4.6) and chronic GVHD (HR = 1.8, 95% CI 1.4-2.2). Total body irradiation (TBI) (HR = 1.0, 95% CI 0.8-1.3) was not associated with an increased risk of CKD. CKD is relatively common among survivors of HCT. The presence of ARF and GVHD, but not receipt of TBI, appears to be associated with the occurrence of CKD.