Renal Dysfunction and Elevated Blood Pressure in Long-Term Childhood Cancer Survivors

Abstract

SummaryBackground and objectives Little is known about renal function and blood pressure (BP) in long-term childhood cancer survivors. This cross-sectional study evaluated prevalence of these outcomes and associated risk factors in long-term childhood cancer survivors at their first visit to a specialized outpatient clinic.Design, Setting, Participants, & Measurements Estimated GFR; percentages of patients with albuminuria, hypomagnesemia, and hypophosphatemia; and BP were assessed in 1442 survivors $5 years after diagnosis. Multivariable logistic regression analyses were used to estimate effect of chemotherapy, nephrectomy, and radiation therapy on the different outcomes.Results At a median age of 19.3 years (interquartile range, 15.6-24.5 years), 28.1% of all survivors had at least one renal adverse effect or elevated BP. The median time since cancer diagnosis was 12.1 years (interquartile range, 7.8-17.5 years). High BP and albuminuria were most prevalent, at 14.8% and 14.5%, respectively. Sixty-two survivors (4.5%) had an estimated GFR ,90 ml/min per 1.73 m 2 . Survivors who had undergone nephrectomy had the highest risk for diminished renal function (odds ratio, 8.6; 95% confidence interval [CI], 3.4-21.4). Combined radiation therapy and nephrectomy increased the odds of having elevated BP (odds ratio, 4.92; 95% CI, 2.63-9.19), as did male sex, higher body mass index, and longer time since cancer treatment.Conclusion Almost 30% of survivors had renal adverse effects or high BP. Therefore, monitoring of renal function in high-risk groups and BP in all survivors may help clinicians detect health problems at an early stage and initiate timely therapy to prevent additional damage.

Glomerular Function Time Trends in Long-Term Survivors of Childhood Cancer: A Longitudinal Study

“…As in line with our results, previous cross-sectional studies showed that higher ifosfamide and cisplatin doses, and nephrectomy were associated with diminished GFR (12)(13)(14)18). Moreover, we observed that HD-cyclophosphamide was related with a lower GFR, but not with a GFR <90 mL/min/1.73 m 2 .…”

“…Recently, we showed in a large cross-sectional cohort study, including 1,442 CCS with a median followup of 12 years after diagnosis, that 28% had 1 renal late effect (s), of whom, 62 (4.6%) developed glomerular dysfunction (GFR <90 mL/min/1.73 m 2 ). Higher ifosfamide, cisplatin, and carboplatin dose, high-dose (HD-)cyclophosphamide, nephrectomy, and longer follow-up were identified as risk factors for glomerular dysfunction (18).…”

Long-Term Nephrotoxicity in Adult Survivors of Childhood Cancer

“…Hypertension was present in 23%, which is relatively high compared with previous findings of 14% and 19% among childhood survivors; this finding could be explained by the fact that survivors were older and follow-up time was longer in the current study (28,45,46). This percentage was even higher (31%) in survivors treated with unilateral nephrectomy.…”

“…However, in these studies, follow-up time was relatively short, and patient numbers were small. A recent study in a large cohort of childhood cancer survivors 12 years after diagnosis described nephrectomy and the combination of nephrectomy with abdominal radiotherapy as risk factors for renal damage, represented by hypertension, proteinuria, and reduced glomerular function (28). In the present study, with a median follow-up of 18 years, we showed that nephrectomy and the combination of nephrectomy with abdominal radiotherapy were associated with a decreased glomerular function and albuminuria but not tubular dysfunction.…”

Childhood cancer survivors: Considerations for surgeons in the transition from pediatric to adult care

“…A Dutch study of 1442 CCS demonstrated that survivors who had undergone nephrectomy had an almost 9-fold increase in their risk for diminished renal function [as measured by glomerular filtration rate (GFR)]. 18 A second study of 763 adult CCS demonstrated that nephrectomy increased the risk for decreased glomerular function, although most survivors maintained their GFR within the normal range. 19 There was also a higher risk for hypertension among those survivors treated with nephrectomy-almost a third had elevated blood pressure.…”