Renal risk differences between diffuse large B-cell lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma: implications for supportive oncology care.

PURPOSE: Diffuse large B-cell lymphoma (DLBCL) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) differ markedly in disease biology and treatment intensity, yet comparative renal outcome data are limited. We compared acute kidney injury (AKI) and chronic kidney disease (CKD) incidence between demographically matched DLBCL and CLL/SLL cohorts.

METHODS

Retrospective cohort study using the TriNetX Global Collaborative Network (143 healthcare organizations; data extracted May 9, 2025). Adults with DLBCL (ICD-10 C83.3) or CLL/SLL (C91.1, C83.0) underwent 1:1 propensity score matching for age, sex, race, and ethnicity. AKI (N17) and CKD (N18) were assessed from day 1 post-index through each patient's available follow-up (an open-ended window; no fixed follow-up duration was generated). Risk differences, risk ratios, and odds ratios (ORs) with 95% CIs were calculated using two-proportion z-tests.

RESULTS

After matching, 19,438 patients (9719/cohort) were analyzed. AKI occurred in 22.9% of DLBCL versus 20.9% of CLL/SLL patients (risk difference 2.0%, 95% CI 0.8-3.1%; risk ratio 1.094, 95% CI 1.037-1.154; OR 1.122, 95% CI 1.048-1.201, p = 0.001). CKD occurred in 18.8% of DLBCL versus 22.7% of CLL/SLL patients (risk difference -4.0%, 95% CI -5.1 to -2.8%; risk ratio 0.825, 95% CI 0.781-0.872; OR 0.785, 95% CI 0.732-0.842, p < 0.001). Demographic characteristics were well balanced (SMD 0.001-0.038). Comorbidities and follow-up duration were not captured by this matching algorithm and are addressed as limitations.

CONCLUSION

DLBCL showed modestly higher AKI risk and CLL/SLL showed modestly higher CKD burden in this demographically matched cohort. Because comorbidities were not matched and absolute differences were small, these findings are hypothesis-generating, supporting attention to renal monitoring in both subtypes pending comorbidity-adjusted, prospective confirmation.