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. 2021 Feb;32(2):495-501.
doi: 10.1681/ASN.2020071002. Epub 2020 Nov 12.

Childhood Cancer and the Risk of ESKD

Ronit Calderon-Margalit  1 , Oren Pleniceanu  2   3   4 , Dorit Tzur  3 , Michal Stern-Zimmer  5 , Arnon Afek  2   6 , Tomer Erlich  2   3   7 , Guy Verhovsky  3   8   9 , Lital Keinan-Boker  10   11 , Karl Skorecki  12   13 , Gilad Twig  3   14   15   16 , Asaf Vivante  2   5   14
Affiliations

Childhood Cancer and the Risk of ESKD

Ronit Calderon-Margalit et al. J Am Soc Nephrol. 2021 Feb.

Abstract

Background: Increasing cancer incidence among children alongside improved treatments has resulted in a growing number of pediatric cancer survivors. Despite childhood cancer survivors' exposure to various factors that compromise kidney function, few studies have investigated the association between childhood cancer and future kidney disease.

Methods: To assess the risk of ESKD among childhood cancer survivors, we conducted a nationwide, population-based, retrospective cohort study that encompassed all Israeli adolescents evaluated for mandatory military service from 1967 to 1997. After obtaining detailed histories, we divided the cohort into three groups: participants without a history of tumors, those with a history of a benign tumor (nonmalignant tumor with functional impairment), and those with a history of malignancy (excluding kidney cancer). This database was linked to the Israeli ESKD registry to identify incident ESKD cases. We used Cox proportional hazards models to estimate the hazard ratio (HR) of ESKD.

Results: Of the 1,468,600 participants in the cohort, 1,444,345 had no history of tumors, 23,282 had a history of a benign tumor, and 973 had a history of malignancy. During a mean follow-up of 30.3 years, 2416 (0.2%) participants without a history of tumors developed ESKD. Although a history of benign tumors was not associated with an increased ESKD risk, participants with a history of malignancy exhibited a substantially elevated risk for ESKD compared with participants lacking a history of tumors, after controlling for age, sex, enrollment period, and paternal origin (adjusted HR, 3.2; 95% confidence interval, 1.3 to 7.7).

Conclusions: Childhood cancer is associated with an increased risk for ESKD, suggesting the need for tighter and longer nephrological follow-up.

Keywords: ESKD; cancer; pediatric nephrology.

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Figures

Figure 1.
Figure 1.
Participant assessment, designation, and outcome. “Benign” tumors were defined as nonmalignant tumors resulting in functional impairment, including gynecologic, endocrine, central nervous system, and skin tumors. The five that developed ESRD included four solid tumors and one leukemia.
Figure 2.
Figure 2.
Cumulative incidence of ESKD in the different participant subgroups.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A: Cancer statistics, 2018. CA Cancer J Clin 68: 7–30, 2018 - PubMed
    1. Stern-Zimmer M, Calderon-Margalit R, Skorecki K, Vivante A: Childhood risk factors for adulthood chronic kidney disease [published online ahead of print June 4, 2020]. Pediatr Nephrol 10.1007/s00467-020-04611-6 - PubMed
    1. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. .; Childhood Cancer Survivor Study: Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 355: 1572–1582, 2006 - PubMed
    1. Bonnesen TG, Winther JF, Asdahl PH, de Fine Licht S, Gudmundsdottir T, Sällfors Holmqvist A, et al. .; ALiCCS study group: Long-term risk of renal and urinary tract diseases in childhood cancer survivors: A population-based cohort study. Eur J Cancer 64: 52–61, 2016 - PubMed
    1. McMahon KR, Harel-Sterling M, Pizzi M, Huynh L, Hessey E, Zappitelli M: Long-term renal follow-up of children treated with cisplatin, carboplatin, or ifosfamide: A pilot study. Pediatr Nephrol 33: 2311–2320, 2018 - PubMed