Kidney Week

Abstract: SA-PO0202

eGFR Discrepancy Based on Serum Creatinine vs. Cystatin C Predicts AKI Following Allogeneic Hematopoietic Cell Transplantation (HCT)

Session Information

• Onconephrology: MGRS, HSCT, Electrolytes, RCC, and More
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Chewcharat, Api, Brigham and Women's Hospital, Boston, Massachusetts, United States

Api Chewcharat, MD, MPH

• Anumolu, Rajesh, University of Massachusetts Amherst, Amherst, Massachusetts, United States

Rajesh Anumolu, MBBS

• Yamada, Sofia, Brigham and Women's Hospital, Boston, Massachusetts, United States

Sofia Yamada, MD

• Ortega, Jessica L., Brigham and Women's Hospital, Boston, Massachusetts, United States

Jessica L. Ortega

• Mehta, Ansh Krishnachandra, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Ansh Krishnachandra Mehta, MD, MBBS

• Defilipp, Zachariah, Massachusetts General Hospital, Boston, Massachusetts, United States

Zachariah Defilipp, MD

• Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States

David E. Leaf, MD, MS, MSc, FASN

• Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States

Meghan E. Sise, MD, MS

• Shapiro, Roman, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Roman Shapiro, MD

• Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States

Shruti Gupta, MD, MPH

Background

Discrepancies between estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr; eGFR_cr) vs. cystatin C (eGFR_cys), have been associated with AKI, the need for kidney replacement therapy (KRT), and mortality in patients with cancer and in other contexts. However, its impact on outcomes in HCT population has not been studied

Methods

We prospectively collected serum cystatin C levels in adults undergoing allogeneic HCT at 2 major academic centers starting in Jan 2024. The primary exposure was a ≥30% discrepancy between eGFR_cr and eGFR_cys. eGFR was calculated based on SCr and Cys values obtained in the 30 days preceding conditioning chemotherapy. The primary outcome was time-to-AKI in the first 90 days following HCT. AKI was defined as 50% increase in SCr or receipt of KRT. We used multivariable Cox regression to adjust for confounders, with death as a competing risk.

Results

Of 275 patients receiving HCT, 86 (31%) had a discrepancy in eGFR. The 90-day incidence of AKI was higher among those with an eGFR discrepancy compared to those without (60.5% vs 43.9%) (Figure 1). eGFR discrepancy was associated with a higher hazard of AKI or receipt of KRT within 90 days after adjusting for key patient and transplant-specific characteristics (HR = 1.59, 95% CI: 1.08-2.35; p-value = 0.02). Over a median of 158 days [IQR: 98-166], there was a non-significant trend toward higher all-cause mortality among those with eGFR discrepancy (HR = 1.99, 95% CI: 0.86–4.60; p = 0.11)

Conclusion

eGFR discrepancy in SCr vs. cystatin C was associated with a higher risk of AKI, and a trend towards higher all-cause mortality among allogeneic HCT recipients.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025mkwkftwx