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Renal dysfunction and elevated blood pressure in long-term childhood cancer survivors
Sebastiaan L Knijnenburg1, Monique W Jaspers, Helena J van der Pal
1Department of Pediatric Oncology, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands. S.L.Knijnenburg@amc.uva.nl
Insights
Nearly 30% of childhood cancer survivors experience renal issues or high blood pressure (BP) long after treatment. Monitoring these health outcomes is crucial for early detection and intervention to prevent further damage.
Area of Science:
- Pediatric Oncology
- Nephrology
- Cardiology
Background:
- Long-term health outcomes for childhood cancer survivors, particularly renal function and blood pressure (BP), are not well understood.
- This study addresses the knowledge gap regarding the prevalence of renal adverse effects and elevated BP in this population.
Purpose of the Study:
- To evaluate the prevalence of renal dysfunction and elevated blood pressure (BP) in long-term childhood cancer survivors.
- To identify risk factors associated with these adverse health outcomes in survivors.
Main Methods:
- A cross-sectional study assessed estimated glomerular filtration rate (eGFR), albuminuria, hypomagnesemia, hypophosphatemia, and BP in 1442 survivors.
- Multivariable logistic regression analyzed the impact of chemotherapy, nephrectomy, and radiation therapy on renal and BP outcomes.
- Data were collected at the first visit to a specialized outpatient clinic for survivors at least 5 years post-diagnosis.
Main Results:
- 28.1% of survivors exhibited at least one renal adverse effect or elevated BP.
- The most common issues were high BP (14.8%) and albuminuria (14.5%).
- Nephrectomy significantly increased the risk of diminished renal function (OR, 8.6), while combined radiation and nephrectomy elevated BP risk (OR, 4.92).
Conclusions:
- A substantial proportion of childhood cancer survivors face long-term renal and cardiovascular challenges.
- Regular monitoring of renal function in high-risk groups and BP in all survivors is recommended.
- Early detection and timely intervention are key to preventing progressive damage and improving long-term health for survivors.
Background And Objectives:
Little is known about renal function and blood pressure (BP) in long-term childhood cancer survivors. This cross-sectional study evaluated prevalence of these outcomes and associated risk factors in long-term childhood cancer survivors at their first visit to a specialized outpatient clinic.
Design, Setting, Participants, & Measurements:
Estimated GFR; percentages of patients with albuminuria, hypomagnesemia, and hypophosphatemia; and BP were assessed in 1442 survivors ≥5 years after diagnosis. Multivariable logistic regression analyses were used to estimate effect of chemotherapy, nephrectomy, and radiation therapy on the different outcomes.
Results:
At a median age of 19.3 years (interquartile range, 15.6-24.5 years), 28.1% of all survivors had at least one renal adverse effect or elevated BP. The median time since cancer diagnosis was 12.1 years (interquartile range, 7.8-17.5 years). High BP and albuminuria were most prevalent, at 14.8% and 14.5%, respectively. Sixty-two survivors (4.5%) had an estimated GFR <90 ml/min per 1.73 m(2). Survivors who had undergone nephrectomy had the highest risk for diminished renal function (odds ratio, 8.6; 95% confidence interval [CI], 3.4-21.4). Combined radiation therapy and nephrectomy increased the odds of having elevated BP (odds ratio, 4.92; 95% CI, 2.63-9.19), as did male sex, higher body mass index, and longer time since cancer treatment.
Conclusion:
Almost 30% of survivors had renal adverse effects or high BP. Therefore, monitoring of renal function in high-risk groups and BP in all survivors may help clinicians detect health problems at an early stage and initiate timely therapy to prevent additional damage.
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