Abstract:

Background: Classical BCR::ABL-negative myeloproliferative neoplasms (MPN), which mainly include essential thrombocytopenia (ET), polycythemia vera (PV) and primary myelofibrosis (PMF), characterized by the overproduction of mature myeloid blood cell lineages and commonly complicate with thrombosis. Recently, reports of MPN related kidney dysfunction especially chronic kidney disease gradually gained attention. However, the clinical characteristics of CKD in MPN patients is still unclear.

Aim: The aim of this study was to investigate the clinical characteristics and risk factors of complicated with CKD in patients with MPN.

Methods: We retrospectively analyzed the clinical characteristics and genetic characteristics of MPN patients who visited Nanfang hospital regularly from June 2008 to December 2023. The predictors of complicated with CKD and over survival (OS) were analyzed by logistic regression or Cox proportional hazards model.

Result: A total of 1373 patients were included, 15.4% of whom had CKD. 1216 clonal hematopoiesis of indeterminate potential (CHIP) related mutations were detected.78.6% of patients had at least one CHIP-related mutation. Patients with CHIP-related mutations were more likely to be older, with 24% being ≥ 65 years of age compared with 7.2% in non-CHIP-related mutation (P < 0.001), and also had fewer CALR mutations (8.1% vs. 27.6%, p < 0.001), and a higher incidence of cardiovascular events, hypertension, diabetes and CKD (25.3% vs. 11.3%, P<0.001; 10.6% vs. 5.8%, P = 0.014; 13% vs. 8.5%, P = 0.040; 17.3% vs. 8.5%, P < 0.001).The multivariate logistic analysis indicated that age ≥65 years old (HR:0.95, 95% CI, 0.94-0.97, p < 0.001), mutation in TET2 (HR:6.54, 95% CI, 2.88-14.88, p < 0.001)、ASXL1 (HR: 2.29, 95% CI, 1.00-5.24,p = 0.049), complicated with cardiovascular events (HR:90.82, 95% CI, 48.62-169.65, p < 0.001), hypertension (HR: 3.42, 95% CI, 1.94-6.03, p < 0.001) and diabetes (HR: 2.16, 95% CI, 1.31-3.54, p = 0.002) are risk factors for CKD in MPN. The multivariable COX analysis revealed that age ≥ 65 years old (HR: 1.88, 95% CI, 1.20 - 2.96, P = 0.006), diagnosed PMF (HR: 11.23, 95% CI, 6.36 - 19.82, P < 0.001), complicated with CKD (HR: 3.48, 95% CI, 2.15 - 5.64, P < 0.001) were the unfavorable predictors of OS, while female (HR: 0.50, 95% CI, 0.34 - 0.75, P < 0.001) was the favorable factors.

Conclusion: Our single-center data indicates that MPN patients have a 15.4% incidence rate of complicated with CKD. Age ≥65 years old, mutation in TET2, ASXL1, complicated with cardiovascular events, hypertension and diabetes are independent risk factors for CKD in MPN patients. Diagnosed PMF, male, complicated with CKD were the unfavorable factors for OS.

Keywords: Myeloproliferative neoplasms; Chronic kidney disease; Clonal hematopoiesis; Clonal hematopoiesis of indeterminate potential

Disclosures

No relevant conflicts of interest to declare.

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2024
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