Long-Term Kidney and Cardiovascular Complications in Pediatric Cancer Survivors - 19/04/23
, Ajibike Lapite, MD, MPHTM 2, Walter Faig, PhD 3, Maya Abdel-Megid, BA 1, Claire Carlson, RN 4, Wendy Hobbie, CRNP 4, Jill Ginsberg, MD 4, 5, Benjamin Laskin, MD, MS 1, 5, Michelle Denburg, MD, MSCE 1, 5Abstract |
Objective |
The objective of this study was to describe the burden of adverse kidney and hypertension outcomes in patients evaluated by pediatric nephrology in a multidisciplinary survivorship clinic.
Study design |
Retrospective chart review of all patients followed up by nephrology in our multidisciplinary survivorship clinic from August 2013 to June 2021. Data included clinic blood pressure, longitudinal ambulatory blood pressure monitoring (ABPM), echocardiography, serum creatinine, and first-morning urine protein/creatinine ratios. For patients with multiple ABPMs, results of initial and most recent ABPMs were compared.
Results |
Of 422 patients followed in the multidisciplinary cancer survivorship clinic, 130 were seen by nephrology. The median time after therapy completion to first nephrology visit was 8 years. The most common diagnoses were leukemia/myelodysplastic syndrome (27%), neuroblastoma (24%), and Wilms tumor (15%). At the last follow-up, 68% had impaired kidney function, 38% had a clinical diagnosis of hypertension, and 12% had proteinuria. There were 91 ABPMs performed in 55 (42%) patients. Patients with multiple ABPMs (n = 21) had statistically significant reductions in overall median blood pressure loads: systolic initial load 37% vs most recent 10% (P = .005) and diastolic load 36% vs 14% (P = .017). Patients with impaired kidney function were more likely to have received ifosfamide. Patients with hypertension were more likely to have received total body irradiation or allogeneic stem cell transplant.
Conclusions |
History of leukemia/myelodysplastic syndrome, neuroblastoma, and Wilms tumor was frequent among survivors seen by nephrology. There was significant improvement in cardiovascular measures with increased recognition of hypertension and subsequent treatment.
Le texte complet de cet article est disponible en PDF.Keywords : onconephrology, chronic kidney disease, hypertension, ambulatory blood pressure monitoring, late effects, survivorship
Abbreviations : ABPM, BP, CKD, eGFR, GFR, LVMI, TBI
Plan
| This study was supported by The Children's Hospital of Philadelphia Pediatric Center of Excellence in Nephrology and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number P50DK114786. B.L. is supported by DK125418. M.D. receives research funding from the National Institutes of Health, Patient Centered Outcomes Research Institute, and Mallinckrodt Pharmaceuticals; she is also on the Editorial Board for Kidney International Reports. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest. |
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| Presented at Pediatric Academic Societies 2022 (poster) on April 24, 2022, Denver, Colorado. |
Vol 255
P. 89 - avril 2023 Retour au numéro
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