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

Autor:	Green DM; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee., Wang M; Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee., Krasin M; Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee., Srivastava D; Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee., Onder S; Division of Nephrology, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee.; Division of Nephrology, Department of Pediatrics, LeBonheur Children's Hospital, Memphis, Tennessee., Jay DW; Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee., Ness KK; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee., Greene W; Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee., Lanctot JQ; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee., Shelton KC; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee., Zhu L; Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee., Mulrooney DA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.; Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee., Ehrhardt MJ; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee., Davidoff AM; Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee.; Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee., Robison LL; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee., Hudson MM; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.; Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2021 Apr; Vol. 32 (4), pp. 983-993. Date of Electronic Publication: 2021 Mar 02.
DOI:	10.1681/ASN.2020060849
Abstrakt:	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. (Copyright © 2021 by the American Society of Nephrology.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu