Kidney Week

Abstract: TH-OR95

Cystatin C-Defined AKI in Children Treated with Cisplatin

Session Information

• Onconephrology and Precision Pharmacology
  November 02, 2023 | Location: Room 107, Pennsylvania Convention Center
  Abstract Time: 05:06 PM - 05:15 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Hessey, Erin, University of Toronto, Toronto, Ontario, Canada

Erin Hessey, MD, MSc

• McMahon, Kelly, McGill University Health Centre, Montreal, Quebec, Canada

Kelly McMahon,

• Blydt-Hansen, Tom D., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada

Tom D. Blydt-Hansen,

• Mammen, Cherry, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada

Cherry Mammen,

• Zappitelli, Michael, University of Toronto, Toronto, Ontario, Canada

Michael Zappitelli,

Background

Cisplatin chemotherapy causes acute kidney injury (AKI). Early AKI detection and mitigation may prevent long-term sequelae. Serum Cystatin C (CysC) may be an early AKI biomarker compared to SCr and is not impacted by muscle mass. We: 1) compared AKI defined by acute CysC change (CysC-AKI) to SCr-defined AKI (SCr-AKI) in children treated with cisplatin; 2) evaluated the relation of a) urine neutrophil gelatinase-associated lipocalin [NGAL] and kidney injury molecule-1 [KIM-1] with CysC-AKI and SCr-AKI and b) of CysC with SCr-AKI.

Methods

12-centre prospective study of 159 children receiving cisplatin. Exclusions: CKD, missing CysC or baseline SCr. At early cisplatin infusions (1st or 2nd cisplatin cycle), SCr, CysC, urine NGAL and KIM-1 were measured pre-/post-infusion and at discharge. Outcomes: KDIGO SCr-AKI (yes/no). CysC-AKI was ≥1.5x rise from baseline or CysC-GFR<35ml/min/1.73m². We calculated kappa statistic for agreement of AKI definitions, Mann-Whitney U test to compare biomarker levels by AKI, and area under the curve (AUC) for a) NGAL/KIM-1 to predict CysC-AKI and SCr-AKI and b) for CysC to predict SCr-AKI.

Results

154 children included (51% male, median age [IQR] 5.6 [2.4-11.7] years). SCr-AKI 7/154 (5%), CysC-AKI 25/154 (16%), 83% agreement (kappa=0.13, p=0.025). There was no significant difference in NGAL or KIM-1 concentrations by SCr-AKI or CysC-AKI at all time points (Figure1). Pre- and post-infusion NGAL performed similarly to predict SCr-AKI and CysC-AKI (Figure1). KIM-1 poorly predicted SCr-AKI and CysC-AKI (Figure1). Pre-infusion CysC had the highest AUC for predicting SCr-AKI (AUC 0.56).

Conclusion

CysC-AKI had a low level of agreement with SCr-AKI in children treated with cisplatin. CysC was not a strong predictor of SCr-AKI in this population. Future studies with more measurement time points are needed to determine if this is possibly due to earlier rise of CysC compared to SCr. NGAL and KIM-1 did not strongly predict AKI by either definition.