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Acute kidney injury common in kids with cancer

11 May 2019

Acute kidney injury (AKI) commonly occurs within a year after cancer diagnosis in paediatric patients and is tied to long-term deteriorations in renal function, a recent study has found.

Researchers retrospectively reviewed the medical records of 1,868 children (1,059 males) who were diagnosed with cancer at a median age of 7.9 years. The Kidney Disease: Improving Global Outcomes criteria was used to assess AKI; impaired renal function was defined as proteinuria and an estimated glomerular filtration rate <90 mL/min/1.73 m2.

More than half (52.6 percent; n=983) of the patients developed a total of 1,864 AKI episodes in the first year after cancer diagnosis. The cumulative incidence rates at 2 weeks, 3 months and 1 year after diagnosis were 28.19 percent, 39.6 percent and 53.6 percent respectively. Children with acute myeloid leukaemia (AML; 88.4 percent) and acute lymphoblastic leukaemia (ALL; 77.2 percent) had the highest 1-year cumulative AKI incidence rates.

Almost half (46.1 percent; n=860) of all AKI episodes were stage 1, while 38.3 percent (n=714) were stage 2 and 15.6 percent (n=290) were stage 3. The 1-year cumulative incidence rate of stage 3 AKI was 12.3 percent, and this was highest in those with ALL (27.9 percent) and lowest in patients with Wilms tumour (2.1 percent).

Analysis of long-term renal outcomes was performed in 1,096 participants. After a median follow-up of 5.17 years, the median eGFR was 107.63 mL/min/1.73 m2. A total of 248 participants (22.6 percent) had eGFR <90 mL/min/1.73 m2 and were thus determined to have impaired renal function. Multivariable analysis revealed that having more than four AKI episodes was a significant risk factor for renal impairment.

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