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

## TL;DR

This study examines chronic kidney disease in children who received stem cell transplants, identifying risk factors like malnutrition and iron overload.

## Contribution

The study identifies novel risk factors for CKD in pediatric HSCT recipients, including AKI severity, hypertension, malnutrition, and iron overload.

## Key findings

- Higher baseline eGFR is associated with a lower risk of developing CKD.
- AKI severity, hypertension, malnutrition, and iron overload are significant risk factors for CKD.
- Female sex is protective against CKD development.

## Abstract

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.

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.

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.

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.