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Abstract: SA-PO129

AKI and CKD in Pediatric Cancer Survivors

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Zeid, Ahmed S., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Delap, Sara M., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Olshefski, Randal S., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Stanek, Joseph, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Guthrie, Lory, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Zepeda-Orozco, Diana, Nationwide Children's Hospital, Columbus, Ohio, United States
Background

Pediatric cancer survivors are exposed to nephrotoxins and procedures during treatment that put them at risk of kidney disease. Here we evaluated factors associated with acute kidney injury (AKI) and chronic kidney disease (CKD) in a cohort of pediatric cancer survivors.

Methods

This was a retrospective chart review that included pediatric cancer survivors who received nephrotoxic chemotherapy, irradiation treatment, and/or had pelvic tumors and were under follow-up at Nationwide Children’s Hospital between 01/01/2011 and 06/30/2021. Patients with pre-existing kidney disease were excluded. Variables included demographics, primary malignancy, nephrotoxin and radiotherapy exposures, nephrectomy, and last encounter’s laboratory results. AKI was defined as stage 2 or 3 AKI by KDIGO creatinine-based guidelines during therapy. CKD was defined as eGFR < 90 ml/min/1.73 m2 per Schwartz calculation at the date of last follow-up. Data were summarized and factors associated with AKI and CKD were analyzed with logistic regression models.

Results

A total of 128 patients met the inclusion criteria. The median age at cancer diagnosis was 5.4 years and the median duration of follow-up was 6 years. Twenty-six AKI episodes were identified in 25 patients (19.5%). The incidence was more in hematological malignancies (68%) and 41% occurred in the first month after cancer diagnosis. Patients with AKI were more likely to have impaired initial GFR (OR=0.96; p=0.0023). The leading etiology for AKI was dehydration (Table 1). A nephrologist was consulted in 39% of AKI episodes. Eighteen patients developed CKD during follow-up (14%); of whom 2 were followed by a nephrologist. Solid tumors survivors accounted for 83.3% of patients with CKD. Risk factors associated with CKD included nephrectomy (OR=10.5; p=0.005), carboplatin (OR=3.03; p=0.0364), Ifosfamide (OR=8.89; p=0.002), and vincristine (OR=6.7; p=0.0040). There was no significant association between AKI and CKD development in cancer survivors (OR=1.73; p=0.35).

Conclusion

Renal complications in pediatric cancer patients are common. In our cohort, renal service involvement in the management of patients with AKI and CKD was limited. Nevertheless, we believe it is crucial for proper diagnosis and management.

Table 1: Causes of AKI in our cohort
Possible etiology of AKITumor lysis syndromeDehydration due to fluid losses or poor intake.Drug related nephrotoxicityShock and hypotensionMalignant infiltration of the kidneyUrinary tract obstruction by tumorGlomerulonephritis
Number of episodes61043111