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. 2021 Apr;32(4):983-993.
doi: 10.1681/ASN.2020060849. Epub 2021 Mar 2.

Kidney Function after Treatment for Childhood Cancer: A Report from the St. Jude Lifetime Cohort Study

Daniel M Green  1   2 , Mingjuan Wang  3 , Matthew Krasin  4 , DeoKumar Srivastava  3 , Songul Onder  5   6 , Dennis W Jay  7 , Kirsten K Ness  1 , William Greene  8 , Jennifer Q Lanctot  1 , Kyla C Shelton  1 , Liang Zhu  3 , Daniel A Mulrooney  1   2   9 , Matthew J Ehrhardt  1   2 , Andrew M Davidoff  9   10 , Leslie L Robison  1 , Melissa M Hudson  1   2   9
Affiliations

Kidney Function after Treatment for Childhood Cancer: A Report from the St. Jude Lifetime Cohort Study

Daniel M Green et al. J Am Soc Nephrol. 2021 Apr.

Abstract

Background: Survivors of childhood cancer may be at increased risk for treatment-related kidney dysfunction. Although associations with acute kidney toxicity are well described, evidence informing late kidney sequelae is less robust.

Methods: To define the prevalence of and risk factors for impaired kidney function among adult survivors of childhood cancer who had been diagnosed ≥10 years earlier, we evaluated kidney function (eGFR and proteinuria). We abstracted information from medical records about exposure to chemotherapeutic agents, surgery, and radiation treatment and evaluated the latter as the percentage of the total kidney volume treated with ≥5 Gy (V5), ≥10 Gy (V10), ≥15 Gy (V15), and ≥20 Gy (V20). We also used multivariable logistic regression models to assess demographic and clinical factors associated with impaired kidney function and Elastic Net to perform model selection for outcomes of kidney function.

Results: Of the 2753 survivors, 51.3% were men, and 82.5% were non-Hispanic White. Median age at diagnosis was 7.3 years (interquartile range [IQR], 3.3-13.2), and mean age was 31.4 years (IQR, 25.8-37.8) at evaluation. Time from diagnosis was 23.2 years (IQR, 17.6-29.7). Approximately 2.1% had stages 3-5 CKD. Older age at evaluation; grade ≥2 hypertension; increasing cumulative dose of ifosfamide, cisplatin, or carboplatin; treatment ever with a calcineurin inhibitor; and volume of kidney irradiated to ≥5 or ≥10 Gy increased the odds for stages 3-5 CKD. Nephrectomy was significantly associated with stages 3-5 CKD in models for V15 or V20.

Conclusions: We found that 2.1% of our cohort of childhood cancer survivors had stages 3-5 CKD. These data may inform screening guidelines and new protocol development.

Keywords: amphotericin B; calcineurin inhibitor; carboplatin; cisplatin; hypertension; ifosfamide; kidney irradiation; long-term survivors; pediatric cancer.

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Figures

Figure 1.
Figure 1.
Study recruitment flow diagram. SJLIFE, St. Jude Lifetime Cohort Study; N, number.
See this image and copyright information in PMC

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