Loss of renal function following bone marrow transplantation: an analysis of angiotensin converting enzyme D/I polymorphism and other clinical risk factors

Chronic renal failure is an acknowledged late complication of BMT, It is re lated to the intensive chemotherapy, radiation and supporting medications. Polymorphism in the angiotensin converting enzyme (ACE) gene is associated with progression of nephropathy caused by diabetes and IgA nephropathy. We sought to determine whether ACE genotype and other clinical factors were as sociated with loss of renal function after BMT, We determined the genotype of 106 adult allogeneic BMT recipients, who received a similar preparative regimen, survived I year, and had assessment of renal function up to 3 year s after BR IT. We found that the distribution of genotypes was similar to t he general population; 29%, 51%, and 20% for the DD, DI, and II genotypes, respectively. There was no statistical difference in patient survival betwe en the three groups. Among all patients, the average creatinine clearance d eclined from 124 (95% CI 117, 131) to 89 (95% CI 78, 100) ml/min over the 3 6 months after BMT. Decline in renal function over time was less for patien ts with the DD compared to the II genotype (P = 0.040), Renal function in p atients with the DD genotype was also better than those with the DI genotyp e, but this was of borderline statistical significance (P = 0.055), Renal s hielding reduced decline in renal function compared to no shielding (P = 0. 026), We conclude that the ACE genotype does not seem to influence survival , but the DI genotype may be protective against renal injury after BR IT. F urthermore, we confirm that renal shielding during TBI reduces the renal in jury after BMT.