Incidence of and risk factors for chronic kidney disease in childhood cancer survivors.

BACKGROUND

Although therapeutic advances have improved the life expectancy of children with cancer, the late complication of chronic kidney disease (CKD) represents a challenge. We aimed to measure the cumulative incidence and identify risk factors for CKD, defined as estimated glomerular filtration rate < 90 mL/min/1.73 m2, in survivors of childhood cancer.

METHODS

We studied children treated for cancer who survived for ≥ 5 years. The cumulative incidence of CKD was measured and risk factors were identified using the Kaplan-Meier method, the log-rank test, and Cox proportional hazards analysis.

RESULTS

Eighty-four survivors, with a median of 5.7 years old at treatment initiation, were studied for a median of 9.0 years. Nineteen, 12, 15, 57, 7 (of 78), 4, 20, 14, and 34 patients received cisplatin, carboplatin, ifosfamide, methotrexate, aminoglycoside, nephrectomy, total-body irradiation, kidney irradiation (≥ 10 Gy), and hematopoietic stem cell transplantation, respectively; and 14 developed relapse/secondary cancer. During treatment, acute kidney injury developed in 57.5% of patients. The cumulative incidence of CKD was 10.7% after 5 years and 21.8% after 10 years. The log-rank test identified older age (≥ 5 years) at treatment initiation, solid tumor, cisplatin therapy, ifosfamide therapy, and nephrectomy as significant risk factors; and a Cox proportional hazards model showed that older age (HR 3.89, p = 0.033), cisplatin therapy (HR 8.80, p < 0.001), and nephrectomy (HR 10.20, p = 0.016) were significant risk factors.

CONCLUSIONS

The long-term monitoring of kidney function is especially important for survivors of childhood cancer who received their initial treatment at an older age, underwent cisplatin-based chemotherapy, or underwent nephrectomy.