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Kidney Week

Abstract: TH-PO045

Urine Biomarkers and AKI Associations with CKD and Hypertension 3 Months Post-Cisplatin in Children

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • McMahon, Kelly, McGill University, Montreal, Quebec, Canada
  • Blydt-Hansen, Tom D., British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
  • Pinsk, Maury N., University of Manitoba, Winnipeg, Manitoba, Canada
  • Mammen, Cherry, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
  • Huynh, Louis, Queen's University, Kingston, Ontario, Canada
  • Yordanova, Mariya, McGill University, Montreal, Quebec, Canada
  • Crépeau-Hubert, Frédérik, McGill University, Montreal, Quebec, Canada
  • Rassekh, Shahrad Rod, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
  • Schultz, Kirk Raymond, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
  • Devarajan, Prasad, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Background

Cisplatin (CisP) causes acute kidney injury (AKI) and may lead to chronic kidney disease (CKD) and hypertension (HTN) in children. Aims: 1) Describe 3-month post-CisP CKD/HTN; 2) Determine if a) AKI during CisP treatment and b) urine neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (uKIM-1) near end of CisP therapy are associated with 3-month CKD/HTN.

Methods

12-site prospective pediatric study. Exposures: a) Serum creatinine (SCr)-AKI during CisP therapy (KDIGO definition); b) Electrolyte AKI(eAKI): low serum Mg++, K+ or PO4- during therapy; c)uNGAL/KIM-1 at discharge from a late CisP cycle. Outcomes: a) CKD: urine albumin/creatinine ratio≥3mg/mmol(≥7.5mg/mmol if <2 years old), urine protein/creatinine ratio≥15mg/mmol or SCr-estimated glomerular filtration rate<90mL/min/1.73m2; b) HTN: blood pressure≥95thpercentile (adults:≥140/90mmHg) or treated for HTN. Univariate tests and multiple logistic regression were performed to evaluate exposure-outcome relations and adjusted associations.

Results

Of 154/158 with 3-month data: 77(50%) boys; median[IQR] age: 6[3-12] years. 96/142(68%) had CKD; 14/141(10%) had HTN; 100/154(65%) had CKD or HTN. SCr-AKI, ≥Stage 2 SCr-AKI and eAKI+SCr-AKI were associated with 3-month HTN(Table). AKI was not associated with CKD(Table). Adjusting for age and gender, only ≥Stage 2 SCr-AKI was associated with 3-month HTN (adjOR 4.4(95% CI 1.1-18.4)). Biomarkers were not associated with CKD or HTN(Table).

Conclusion

CKD and HTN are common 3 months after CisP. AKI is associated with 3-month HTN. Ongoing 3-year follow-up will determine if associations change and/or persist. Measures to reduce HTN after cancer therapy are needed.

Funding

  • Government Support - Non-U.S.