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Background <p>Although therapeutic advances have improved the life expectancy of children with cancer, the late complication of chronic kidney disease (CKD) represents a challenge. We aimed to measure the cumulative incidence and identify risk factors for CKD, defined as estimated glomerular filtration rate &lt; 90&#xa0;mL/min/1.73 m<sup>2</sup>, in survivors of childhood cancer.</p> Methods <p>We studied children treated for cancer who survived for ≥ 5&#xa0;years. The cumulative incidence of CKD was measured and risk factors were identified using the Kaplan–Meier method, the log-rank test, and Cox proportional hazards analysis.</p> Results <p>Eighty-four survivors, with a median of 5.7&#xa0;years old at treatment initiation, were studied for a median of 9.0&#xa0;years. Nineteen, 12, 15, 57, 7 (of 78), 4, 20, 14, and 34 patients received cisplatin, carboplatin, ifosfamide, methotrexate, aminoglycoside, nephrectomy, total-body irradiation, kidney irradiation (≥ 10&#xa0;Gy), and hematopoietic stem cell transplantation, respectively; and 14 developed relapse/secondary cancer. During treatment, acute kidney injury developed in 57.5% of patients. The cumulative incidence of CKD was 10.7% after 5&#xa0;years and 21.8% after 10&#xa0;years. The log-rank test identified older age (≥ 5&#xa0;years) at treatment initiation, solid tumor, cisplatin therapy, ifosfamide therapy, and nephrectomy as significant risk factors; and a Cox proportional hazards model showed that older age (HR 3.89, <i>p</i> = 0.033), cisplatin therapy (HR 8.80, <i>p</i> &lt; 0.001), and nephrectomy (HR 10.20, <i>p</i> = 0.016) were significant risk factors.</p> Conclusions <p>The long-term monitoring of kidney function is especially important for survivors of childhood cancer who received their initial treatment at an older age, underwent cisplatin-based chemotherapy, or underwent nephrectomy.</p> Graphical abstract <p></p>

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Incidence of and risk factors for chronic kidney disease in childhood cancer survivors

  • 期刊论文

  • 发表日期：

    2025年10月10日

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  • Wataru Shimabukuro,
  • Satoru Hamada,
  • Hideki Sakiyama,
  • Shinobu Kiyuna,
  • Tokiko Oshiro,
  • Shogo Nakada,
  • Kazuya Hamada,
  • Noriko Kinjo,
  • Nobuyuki Hyakuna,
  • Koichi Nakanishi

摘要

Background

Although therapeutic advances have improved the life expectancy of children with cancer, the late complication of chronic kidney disease (CKD) represents a challenge. We aimed to measure the cumulative incidence and identify risk factors for CKD, defined as estimated glomerular filtration rate < 90 mL/min/1.73 m2, in survivors of childhood cancer.

Methods

We studied children treated for cancer who survived for ≥ 5 years. The cumulative incidence of CKD was measured and risk factors were identified using the Kaplan–Meier method, the log-rank test, and Cox proportional hazards analysis.

Results

Eighty-four survivors, with a median of 5.7 years old at treatment initiation, were studied for a median of 9.0 years. Nineteen, 12, 15, 57, 7 (of 78), 4, 20, 14, and 34 patients received cisplatin, carboplatin, ifosfamide, methotrexate, aminoglycoside, nephrectomy, total-body irradiation, kidney irradiation (≥ 10 Gy), and hematopoietic stem cell transplantation, respectively; and 14 developed relapse/secondary cancer. During treatment, acute kidney injury developed in 57.5% of patients. The cumulative incidence of CKD was 10.7% after 5 years and 21.8% after 10 years. The log-rank test identified older age (≥ 5 years) at treatment initiation, solid tumor, cisplatin therapy, ifosfamide therapy, and nephrectomy as significant risk factors; and a Cox proportional hazards model showed that older age (HR 3.89, p = 0.033), cisplatin therapy (HR 8.80, p < 0.001), and nephrectomy (HR 10.20, p = 0.016) were significant risk factors.

Conclusions

The long-term monitoring of kidney function is especially important for survivors of childhood cancer who received their initial treatment at an older age, underwent cisplatin-based chemotherapy, or underwent nephrectomy.

Graphical abstract