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

Background 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. Methods 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. Results 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) μ mol/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 m 2 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. Conclusion 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.