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Abstract: TH-PO075

AKI in Pediatric Cancer Patients: Incidence and Outcome

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Park, Peong Gang, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Kang, Eunjeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Park, Minsu, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Ahn, Yo Han, Seoul National University Bundang Hospital, Seongnam, Kyunggi-do, Korea (the Republic of)
  • Ha, IL-Soo, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Cheong, Hae Il, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Yoon, Hyung-Jin, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Kang, Hee Gyung, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
Background

Pediatric patients with cancer are known to experience acute kidney injury (AKI) but its incidence and clinical impact has not been well established. The purpose of this study is to analyze the incidence of AKI within 1 year of diagnosis of cancer in children, and to assess its impact on the development of impaired renal function and the development of proteinuria.

Methods

Retrospective review of medical records was done on patients who were diagnosed and treated for cancer at Seoul National University Hospital between 2004 and 2013. Patients who were 18 years old or younger at diagnosis of cancer and who had their Cr levels measured at least two times within one year of diagnosis were eligible. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria: stage 1 as 0.3 mg/dL rise of Cr within two days or 1.5 times rise within seven days, stage 2 as two times rise, stage 3 as three times rise or Cr above 4 mg/dL. Impaired renal functionof eGFR of cancer survivors less than 90ml/min/1.73m2, and development of proteinuria were also assessed.

Results

Among 2,170 candidate patients assessed, 1,868 patients were eligible. Patients were diagnosed with cancer at a median age of 7.9 years old. Their median initial eGFR at diagnosis was 90.0ml/min/1.732. A total of 983 patients (52.6%) developed AKI and the cumulative incidence of AKI within two weeks, three months, and one year of diagnosis were 28.9%, 39.6%, 53.6%, respectively. The 1-year cumulative incidence of AKI was the highest in patients with acute myeloid leukemia (88.4%) and lowest in patients treated for retinoblastoma (14.1%). Within the 1 year of cancer diagnosis, AKI occurred once in 520 (27.8%), 2-3 times in 349 (18.7%), more than 4 times in 114 (6.1%) patients. 18.7%, 22.1%, and 11.8% of the patients had stage 1, stage 2, and stage 3 AKI respectively. 22.6% of the survivors had impaired renal function. Male sex, lower eGFR at diagnosis, frequent AKI occurrence and nephrectomy was independent risk factor. Also, 8.2% of the survivors developed proteinuria and female gender, older age were the associated independent risk factors.

Conclusion

Current study showed that AKI occurred in a relatively large percentage of pediatric patients with cancer and that it may adversely affect their long-term renal function.

Funding

  • Government Support - Non-U.S.