Predictors and significance of kidney dysfunction in patients with chronic graft-versus-host disease.
Predictors and significance of kidney dysfunction in patients with chronic graft-versus-host disease.
复制标题
慢性移植物抗宿主病患者肾功能障碍的预测因子和意义。
DOI：
10.1038/s41409-023-02032-1
复制
发表时间：
2023
影响因子：
4.8
通讯作者：
Pavletic,StevenZ
中科院分区：
文献类型：
--
作者：
Beshensky,David;Pirsl,Filip;Holtzman,NoaG;Steinberg,SethM;Mays,JacquelineW;Cowen,EdwardW;Comis,LeoraE;Joe,GalenO;Magone,MTeresa;Schulz,Eduard;Waldman,MerylA;Pavletic,StevenZ
Kidney complications have been studied in allogeneic hematopoietic stem cell transplant patients but not specifically among chronic graft-versus-host disease (cGVHD) patients. Participants (n= 365) enrolled in the cross-sectional cGVHD natural history study (NCT00092235) were assessed for kidney dysfunction and overall survival. Kidney dysfunction was analyzed for associations in univariate and multivariable analyses. Kidney dysfunction (eGFR < 60) was found in 64 patients, and 29 patients had moderate-severe kidney dysfunction (eGFR < 45). Patients with kidney dysfunction were more likely treated with cyclosporine at evaluation or to have received it for GVHD prophylaxis, or prior treatment of GVHD. Patients with kidney dysfunction were less severely affected by cGVHD of skin, mouth, and joints/fascia. In multivariable modeling, history of cyclosporine use (OR = 2.19, 95% CI 1.13–4.25), angiotensin receptor blocker use (OR = 5.57, 95% CI 1.49–20.84), proteinuria (OR = 2.39, 95% CI 1.19–4.79), lower CRP (OR = 0.95, 95% CI 0.91–0.99), lower C3 (OR = 0.98, 95% CI 0.97–0.99), and lower hemoglobin (OR = 0.70, 95% CI 0.58–0.84) were jointly associated with kidney dysfunction. Overall survival was lower in those with moderate-severe kidney dysfunction (p= 0.015), demonstrating the importance of addressing kidney dysfunction in this population. The association of kidney dysfunction with less severe cGVHD suggests an etiology unrelated to cGVHD but potentially a consequence of drug-related toxicities.
