br characteristics male sex lower eGFR at diagnosis below
characteristics: male sex, lower eGFR at diagnosis (below
60 mL/minute/1.73 m2), chemotherapeutic agents administered (especially cyclophosphamide), and nephrec-tomy performed. In the multivariable analysis, the statistically significant risk factors of renal impairment were male sex, lower eGFR at diagnosis, greater number of AKI episodes (more than 4 times), and nephrectomy (Table VI; available at www.jpeds.com). Cancer survivors with or without final eGFR measured did not differ in their percentages of patients who underwent nephrectomy or had AKI. However, the group with final eGFR was more likely to have undergone HSCT or have experienced
relapse. Two of the survivors had final eGFR below 15 mL/minute/1.73 m2. A boy who was treated surgically for colon cancer and who also had underlying Crohn’s disease and complicated renal amyloidosis, is on close observation for his renal dysfunction, although he Dexmedetomidine is not on RRT yet. Another girl with lymphoma who had
experienced AKI more than 4 times, lost her kidney function about 2.5 years from cancer diagnosis and is currently on peritoneal dialysis. All other patients had final eGFRs between 60 mL/minute/1.73 m2 and 90 mL/minute/ 1.73 m2. Urinalysis data were available for 742 survivors, and a total of 61 patients (8.2%) had proteinuria. Proteinuria was most frequent in survivors of AML (13.6%), followed by lymphoma (9.3%).
Our study provides a comprehensive evaluation of the characteristics of AKI, including the incidence, risk factors, and short-term and long-term outcome of AKI in children with cancer, including a large group of patients diagnosed with inclusive cancer types using established criteria for AKI—the KDIGO criteria. Reports on the incidence of AKI in children with cancer have offered variable results
Table II. Cumulative incidence of acute kidney injury, specified*
WT, Wilms tumor. *Cumulative incidence was calculated using survival analysis.
depending on the criteria used for the diagnosis of AKI. For example, although the incidence of AKI in recipients of HSCT was 78% within 1 year after cancer diagnosis in our study, the reported incidence of AKI in recipients of HSCT
was much lower, about 11% and 21%, within a 2-year period in studies that defined AKI as the doubling of Cr levels.13,14 However, when the pRIFLE (Pediatric Risk, Injury, Failure,
Loss, End Stage Renal Disease) criteria were used, the reported incidence of AKI was 84% in recipients of HSCT within 100 days after transplantation, which was slightly higher than the result of our study, although the different timeframe should be considered for a more accurate comparison.16 In a study that used the KDIGO criteria for AKI diagnosis, as in our study, 64% of patients with AML
Number of AKI episodes for each patient (%)
AKI for each patient
Maximum stage of 25
AML Lymphoma NBL
WT Brain tumor Others
AML Lymphoma NBL WT Brain tumor Others
Figure 3. A, Number of AKI episodes; B, Maximum stage of AKI according to cancer group.
Acute Kidney Injury in Pediatric Cancer Patients 247
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Table V. Patient characteristics according to the occurrence of acute kidney injury
who did not experience who experienced P Multivariable analysis
No. (%) of patients who received specific chemotherapeutic agents‡
*The covariates assessed for the multivariable logistic-regression model were sex, initial eGFR at diagnosis, cancer group, chemotherapy, chemotherapy with cyclophosphamide, ifosfamide, or methotrexate; CT scans, HSCT, or relapse. †Reference to OR in multivariable analysis is brain tumor in the cancer group and the absence of the corresponding risk factor.