Higher Prevalence of Chronic Kidney Disease in Myelodysplastic Syndromes Patients Compared to Age- Adjusted General Population - Results from the Polish Adult Leukemia Group (PALG) Registry
Authors: Madry Krzysztof , Jachalska Anna , Szwedyk Pawel , Sosnia Oktawia , Wiater Elzbieta , Obara Agata , Krochmalczyk Dorota , Kopinska Anna , Gajewska Małgorzata , Kulikowska De Nalecz Anna , Kopacz Agnieszka , Olszewska-Szopa Magdalena , Golos Aleksandra , Subocz Edyta , Machowicz Rafal , Hus Iwona , Rydzewska-Rosołowska Alicja , Wasińska-Krawczyk Anna , Basak Grzegorz , Rydzewski Andrzej 
Published: December 2023

Introduction
Chronic comorbidities that are common in the elderly population can have a significant impact on the clinical course, the choice of treatment, and survival of myelodysplastic syndromes (MDS) patients. No studies have focused on the coexistence of two diseases that are common in the elderly population, chronic kidney disease (CKD) and MDS, so the epidemiological data and clinical implications of both diseases occurring together are unknown.
Aims
Primary objective: to assess the prevalence of CKD in patients with MDS in comparison to the age-adjusted general population.
Secondary objective: to evaluate the impact of CKD on clinical course in MDS patients.
Methods
This was a prospective analysis using clinical and laboratory data from MDS patients who were registered in the Polish Adult Leukemia Group (PALG) Registry from 2010 to 2023. Data have been provided by 28 hematologic centers.
CKD was defined as an eGFR &lt; 60 mL/min/1.73m², disregarding albuminuria since urinalysis results were not recorded in the database. The stages of CKD were classified based on eGFR according to the NKF KDOQI National Kidney Foundation Kidney Disease Outcome Quality Initiative guidelines, and eGFR was calculated using CKD-EPI equation.
For comparison of the prevalence of CKD in MDS subjects aged ≥60 years to the general population, we used data from the PolSenior 2 study (covering the years 2018-2019). Data were age and sex standardized using demographic tables from Statistics Poland (https:// demografia.stat.gov.pl/bazademografia/Tables.aspx).
Median survival time was calculated using Kaplan-Meier estimator. Multivariate analysis was performed using Cox regression.
Results
Overall, data (including eGFR) were available for 1813 MDS patients. Median age at diagnosis was 71 years [IQR 64 - 78]. and 55.3% patients were male. Sixty percent of the patients were diagnosed as IPPS lower risk.
At the time of MDS diagnosis, CKD was detected in 479 patients (26.4%). Among patients aged ≥ 60, the crude rate of CKD was 30.3%. The standardized rate of CKD in the general population aged ≥ 60 years was significantly lower than in the similarly aged MDS group, with rates of 13.2% [CI 12.3-14.1] and 25.5% [CI 22.9-28.4]; p&lt;0.001, respectively. (Figure 1)
Patients with CKD were significantly older (median 78 yo) than those without CKD (median 68 yo; p&lt;0.001), and more likely to have diabetes (33.2% vs 19.7%; p&lt;0.001), and to have coincidence of another malignancy (21.6%) than those without CKD (14.9%; p=0.001). Median hemoglobin concentration was significantly lower in the CKD group (8.9 g/dL) than in the non-CKD group (9.4 g/dL; p &lt; 0.05). Subjects with decreased eGFR were more likely to be dependent on RBC transfusion (56.5%) than subjects with eGFR ≥ 60 ml/min per 1.73m 2 (48.9%; p=0.0008).
Median survival of patients with eGFR ≥ 60 ml/min per 1.73m 2 was 2.5 y [CI 1.0-6.1] vs 1.4 y [CI 0.6-4.2] for CKD. In multivariate analysis we found that CKD stage, age ≥ 65, higher IPSS score, high-risk IPSS cytogenetics and ECOG &gt;1 were independent predictors of shorter survival. (Figure 2).
Conclusions
Myelodysplastic syndrome (MDS) subjects are more likely to have chronic kidney disease (CKD) than the general population. The presence of CKD in MDS patients is associated with worse overall survival and higher RBC transfusion requirement.