Renal Function in Childhood Cancer Survivors

Renal function in a large, clinically assessed cohort of childhood cancer survivors was analyzed using data from the St. Jude Lifetime Cohort Study. Daniel M. Green, MD, and colleagues at St. Jude Children’s Research Hospital, Memphis, Tennessee, reported results of the analysis during a poster session at the ASCO 2019 Annual Meeting in a poster titled Renal Function after Treatment for Childhood Cancer: A Report from the St. Jude Lifetime Cohort Study.

Creatinine and qualitative urine protein was measured in 2753 survivors (>10 years post-diagnosis, age ≥18 years). The Kidney Disease International Global Outcomes 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) was used to grade renal function. Associations between demographics, treatment exposures, and CKD grades 1-5 and 3-5 were estimated using multivariable logistic regression models. Radiation treatment was expressed as percentage of total kidney volume treated with 5 (V5), 10 (V10), 15 (V15), and 20 (V20) Gray.

Of the 2753 survivors, 48.7% were female and 82.5% were non-Hispanic white. Median age at diagnosis was 7.3 years, median age at evaluation was 31.4 years, and median time from diagnosis to evaluation was 23.2 years. The prevalence of grades 1-5 CKD was 7.4% and the prevalence of grades 3-5 CKD was 2.1% (grade 1=113; grade 2=30; grade 3=44; grade 4=5, and grade 5=8).

There was no association between CKD and individual and cumulative aminoglycoside doses and treatment with high-dose methotrexate. The cumulative number of doses of ambisome/abelcet and of amphotericin B were significant risk factors for grades 1-5 and grades 3-5 CKD in models for V15 and V20.

In multivariable analyses for V10, there were significant associations between grades 1-5 and body mass index 30 kg/m2 versus <13 to <25 kg/m2 (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.19-2.48; P=.004), and other race/ethnicity versus non-Hispanic white (OR, 1.98; 95% CI, 1.39-2.81; P<.001).

“In addition to nephrotoxic antineoplastic and supportive care therapy, race, ethnicity, and body composition contribute to risk of CKD in long-term survivors. These novel results inform late effects reduction strategies for future treatment protocols and identify survivors at highest risk for CKD,” the researchers said.

Source: Green DM, Wang M, Krasin MJ, et al. Renal function after treatment for childhood cancer: A report from the St. Jude Lifetime Cohort Study. Abstract of a poster presented at the American Society of Clinical Oncology 2019 Annual Meeting, June 1, 2019, Chicago, Illinois.