65 - Long-term Kidney Complications in Pediatric Cancer Survivors: Experience From a Multidisciplinary Survivorship Clinic

Poster Number: 65
Publication Number: 65.341

Wendy C. Hsiao, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Ajibike Lapite, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Walter Faig, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Maya Abdel-Megid, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Claire Carlson, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Wendy Hobbie, Childrens Hospital of Philadelphia, Wynnewood, PA, United States; Jill P. Ginsberg, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Benjamin L. Laskin, Childrens Hospital of Philadelphia, Bala Cynwyd, PA, United States; Michelle Denburg, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Pediatric cancer survivors are at increased risk of chronic kidney disease and hypertension due to nephrotoxic chemotherapies, radiation, and/or nephrectomy. Less is known about which patients are most likely to benefit from long-term nephrology follow-up.

Objective: To describe the burden of adverse kidney outcomes in patients evaluated by pediatric nephrology in a multidisciplinary survivorship clinic (MDSC).

Design/Methods: Retrospective chart review of all patients followed by nephrology in a single-center MDSC from 2013-2021. Data abstracted included demographics, cancer diagnosis and therapy, clinic blood pressures, longitudinal ambulatory blood pressure monitoring (ABPM), antihypertensive therapy, echocardiography, serum creatinine measures, and first-morning urine protein-creatinine ratios. Creatinine-estimated glomerular filtration rate (eGFR) was calculated using the CKiD U25 equation. Standard descriptive statistics were used. For patients with multiple ABPMs, results of initial and most recent ABPMs were compared using the Wilcoxon signed-rank test.

Results: Of 462 patients followed in MDSC, 130 were seen by nephrology. Median time after completion of therapy to first nephrology visit was 8 years (interquartile range 5-11 years). The most common diagnoses were leukemia/myelodysplastic syndrome (MDS) (27%), neuroblastoma (24%), and Wilms tumor (15%) (Table). The most common nephrotoxic chemotherapy received was cyclophosphamide (75%). 71% and 55% had received radiation and stem cell transplant (SCT), respectively. An eGFR < 90 mL/min/1.73m^2 was present in 80 patients (62%), nearly 40% had hypertension (n=50), and 16 patients (12%) had proteinuria. There were 91 ABPMs performed in 55 (42%) patients. There were high proportions of masked hypertension (18%) and severe hypertension (29%) on initial ABPM. Patients with multiple ABPMs (n=21) had statistically significant reductions in overall median systolic (initial 30% vs most recent 10%, p=0.005) and diastolic loads (initial 26% vs most recent 14%, p=0.017). Conclusion(s): History of leukemia/MDS, neuroblastoma, Wilms tumor, and treatment with cyclophosphamide, radiation, and SCT were frequent among survivors seen by nephrology in MDSC. There was a high prevalence of decreased eGFR and hypertension. To our knowledge this is the first study to evaluate longitudinal ABPMs in pediatric cancer survivors. There was significant improvement in ABPM parameters with increased recognition and subsequent treatment. This study highlights the important role of nephrology in survivorship care for high-risk childhood cancer survivors.
Demographics and Cancer History