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

Abstract

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.