Acute Kidney Injury During Cisplatin Therapy and Associations with Kidney Outcomes 2 to 6 months Post-cisplatin in Children: a Multi-centre, Prospective Observational Study

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2022 Oct 19

PMID 36260162

Authors

Kelly R McMahon

Asaf Lebel

Shahrad Rod Rassekh

Kirk R Schultz

Tom D Blydt-Hansen

Geoffrey D E Cuvelier

Cherry Mammen

Maury Pinsk

Bruce C Carleton

Ross T Tsuyuki

Colin J D Ross

Louis Huynh

Mariya Yordanova

Frederik Crepeau-Hubert

Stella Wang

Ana Palijan

Jasmine Lee

Debbie Boyko

Michael Zappitelli

Affiliations

Soon will be listed here.

Abstract

Background: Few studies describe acute kidney injury (AKI) burden during paediatric cisplatin therapy and post-cisplatin kidney outcomes. We determined risk factors for and rate of (1) AKI during cisplatin therapy, (2) chronic kidney disease (CKD) and hypertension 2-6 months post-cisplatin, and (3) whether AKI is associated with 2-6-month outcomes.

Methods: This prospective cohort study enrolled children (aged < 18 years at cancer diagnosis) treated with cisplatin from twelve Canadian hospitals. AKI during cisplatin therapy (primary exposure) was defined based on Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria (≥ stage one). Severe electrolyte abnormalities (secondary exposure) included ≥ grade three hypophosphatemia, hypokalemia, or hypomagnesemia (National Cancer Institute Common Terminology Criteria for Adverse Events v4.0). CKD was albuminuria or decreased kidney function for age (KDIGO guidelines). Hypertension was defined based on the 2017 American Academy of Pediatrics guidelines.

Results: Of 159 children (median [interquartile range [IQR]] age: 6 [2-12] years), 73/159 (46%) participants developed AKI and 55/159 (35%) experienced severe electrolyte abnormalities during cisplatin therapy. At median [IQR] 90 [76-110] days post-cisplatin, 53/119 (45%) had CKD and 18/128 (14%) developed hypertension. In multivariable analyses, AKI was not associated with 2-6-month CKD or hypertension. Severe electrolyte abnormalities during cisplatin were associated with having 2-6-month CKD or hypertension (adjusted odds ratio (AdjOR) [95% CI]: 2.65 [1.04-6.74]). Having both AKI and severe electrolyte abnormalities was associated with 2-6-month hypertension (AdjOR [95% CI]: 3.64 [1.05-12.62]).

Conclusions: Severe electrolyte abnormalities were associated with kidney outcomes. Cisplatin dose optimization to reduce toxicity and clear post-cisplatin kidney follow-up guidelines are needed. A higher resolution version of the Graphical abstract is available as Supplementary information.

Citing Articles

Recommendations for Nutritional Supplementation in Pediatric Oncology: A Compilation of the Facts.

Podpeskar A, Crazzolara R, Kropshofer G, Hetzer B, Rabensteiner E, Meister B Nutrients. 2023; 15(14).

PMID: 37513658 PMC: 10386187. DOI: 10.3390/nu15143239.

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