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Predictors of kidney complications and analysis of hypertension in children with allogeneic hematopoietic stem cell transplantation

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Abstract

Background

This study aimed to determine incidence of kidney complications in pediatric allogeneic hematopoietic stem cell transplantation (HSCT) patients.

Methods

Pediatric allogeneic HSCT patients were included. Post-transplantation urinary system complications were collected from medical records and glomerular filtration rates at last visit compared with clinical parameters. Additionally, 24-h ambulatory blood pressure monitoring was performed.

Results

The study included 165 pediatric patients. Acute kidney injury (AKI) developed in 125 (75.8%) patients of whom 54 (43.2%) had stage 1, 36 (28.8%) stage 2, and 35 (28%) stage 3 AKI. Primary malignant disease and viral infection post-HSCT were associated with increased risk of AKI (OR: 4; 95%CI: 1.2–13, p = 0.022 and OR: 2.9; 95%CI: 1.2–6.8, p = 0.014, respectively). Mean duration of post-HSCT follow-up was 4.4 ± 2.5 years, during which time 8 patients had chronic kidney disease (CKD) (stage 1, 4 patients; stage 2, 3 patients; stage 3, 1 patient). CKD incidence was higher in patients in whom stem cell product was bone marrow + cord blood and mobilized peripheral blood, compared to bone marrow alone (40–37.5% versus 5.1%, p = 0.002). Based on 24-h ABPM, 14.7% and 7.4% of patients with normal office blood pressure had pre-hypertension and hypertension, respectively. In patients with albuminuria/severe albuminuria, daytime and nighttime systolic SDS scores were higher than those without albuminuria/severe albuminuria (p = 0.010 and p = 0.004, respectively).

Conclusions

Incidence of AKI is higher in pediatric HSCT patients with primary malignant disease and those with documented viral infection. Our study highlights the beneficial role of 24-h ABPM as a routine part of standard care of pediatric HSCT recipients.

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Author notes

  1. Anar Gurbanov and Bora Gülhan contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Anar Gurbanov

  2. Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey, 06100

    Bora Gülhan, Fatih Ozaltin, Ali Düzova & Rezan Topaloglu

  3. Department of Pediatrics, Division of Pediatric Hematology, Faculty of Medicine, Hacettepe University, İhsan Doğramacı Children’s Hospital, Bone Marrow Transplantation Unit, Ankara, Turkey

    Barış Kuşkonmaz, Fatma Visal Okur & Duygu Uçkan Çetinkaya

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  1. Anar Gurbanov
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  2. Bora Gülhan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Anar Gurbanov, Bora Gulhan, and Barış Kuşkonmaz. The first draft of the manuscript was written by Anar Gurbanov and Bora Gulhan and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Bora Gülhan.

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Gurbanov, A., Gülhan, B., Kuşkonmaz, B. et al. Predictors of kidney complications and analysis of hypertension in children with allogeneic hematopoietic stem cell transplantation. Pediatr Nephrol 38, 461–469 (2023). https://doi.org/10.1007/s00467-022-05599-x

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