Kidney Week

Abstract: SA-PO204

Late Kidney and Blood Pressure Outcomes after Pediatric Hematopoietic Stem-Cell Transplant: A Systematic Review and Meta-Analysis

Session Information

• Onconephrology: Kidney Outcomes during Cancer Treatment and Nephropathies
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Sun, Carolyn, The Hospital for Sick Children, Toronto, Ontario, Canada

Carolyn Sun

• Masood, Sahrish, The Hospital for Sick Children, Toronto, Ontario, Canada

Sahrish Masood

• Kiyingi, Jenan-Jill, The Hospital for Sick Children, Toronto, Ontario, Canada

Jenan-Jill Kiyingi

• Abrahim, Salma, The Hospital for Sick Children, Toronto, Ontario, Canada

Salma Abrahim, MSc

• Schechter, Tal, The Hospital for Sick Children, Toronto, Ontario, Canada

Tal Schechter, MD

• Lui, Victoria Emily, The Hospital for Sick Children, Toronto, Ontario, Canada

Victoria Emily Lui

• Wang, Stella Qiongbin, The Hospital for Sick Children, Toronto, Ontario, Canada

Stella Qiongbin Wang, MS, MSc

• Zappitelli, Michael, The Hospital for Sick Children, Toronto, Ontario, Canada

Michael Zappitelli, MD, MSc

Background

Pediatric hematopoietic stem cell transplant (HSCT) recipients are at risk for late kidney and blood pressure (BP) outcomes, but existing literature on their prevalence is unclear and outcome assessments differ widely. We evaluated 1) the proportion of patients with late kidney and BP outcomes after pediatric HSCT; 2) the proportion of studies that assess AKI in the first 100-days post-HSCT; 3) kidney and BP outcome definition methods reported.

Methods

Searched MEDLINE, Embase, CINAHL, Web of Science, and Scopus (January 2000–November 2022) for observational studies or clinical trials reporting kidney or BP outcomes, ≥6 months post-pediatric HSCT (excluded: N<20; conference abstracts; non-English/French). Categorical (e.g., CKD) and continuous (e.g., GFR) outcome measures were collected. Two reviewers independently reviewed articles, extracted data, and evaluated study quality; a third reviewer resolved disagreements. Stratified meta-analyses of pooled proportions were performed by HSCT indication (malignancy; non-malignancy; both) using a random-effects model. Heterogeneity was assessed; multiple sensitivity analyses were performed.

Results

12,333 references identified, 45 selected: 36/45(80.0%) and 20/45(44.4%) evaluated late kidney and BP outcomes, respectively; 18/45(40.0%) assessed AKI. Pooled proportions of patients with late kidney and BP outcomes: 15.0% [95% CI 0.11–0.20, I²=87.2%] and 9.0% [95% CI 0.06–0.13, I²=92.2%], respectively. Sensitivity analyses (removing different studies) showed similar estimates. Highest proportions were observed for the malignancy HSCT indication. There was significant heterogeneity in pooled estimates (all, p<0.05). GFR, albuminuria, and proteinuria were used to assess kidney function in 26(72.2%), 4(11.1%) and 4(11.1%) studies, respectively. Definitions for late kidney and BP outcomes were at times undefined and varied greatly.

Conclusion

Late kidney and BP outcomes are common after pediatric HSCT, especially in malignancies, but the literature is exceedingly difficult to interpret. Future research should use well-defined kidney and BP outcome definitions with a goal to study data-driven interventions to reduce long-term kidney health burden.

Funding

• Government Support – Non-U.S.