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Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Defining kidney outcomes in children with acute lymphoblastic leukemia in the modern era
Reeti Kumar1, Suzanne Reed2, Joseph R Stanek2
1Department of Pediatrics, Division Nephrology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27705, USA. reeti.kumar@duke.edu.
Insights
Pediatric acute lymphoblastic leukemia (ALL) patients show high rates of acute kidney injury (AKI) and hypertension (HTN) at diagnosis. However, chronic kidney disease (CKD) development is rare, indicating a generally good mid-term kidney outlook.
Area of Science:
- Pediatric Nephrology
- Pediatric Oncology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Kidney complications, including acute kidney injury (AKI), chronic kidney disease (CKD), and hypertension (HTN), can affect patients with ALL.
- Understanding the incidence of these complications is crucial for patient management and long-term outcomes.
Purpose of the Study:
- To determine the incidence of AKI, CKD, and HTN in pediatric patients diagnosed with ALL.
- To analyze kidney-related outcomes over a 9-year period post-diagnosis.
- To assess the mid-term kidney prognosis for children with ALL.
Main Methods:
- Retrospective cohort study including pediatric ALL patients diagnosed between January 1, 2008, and December 31, 2016.
- Collection of demographic and clinical data, including serum creatinine and blood pressure, at diagnosis and up to 9 years post-diagnosis.
- Analysis of incidence rates for AKI, CKD, and HTN within the studied cohort.
Main Results:
- High incidence of AKI observed in 45.5% of patients at least once.
- Low incidence of CKD noted in 2.3% of patients.
- High incidence of HTN at diagnosis (45.6%), 1 month post-diagnosis (65.8%), and chronic HTN (34.3%).
Conclusions:
- Pediatric ALL patients experience a high incidence of AKI at diagnosis.
- The development of CKD is infrequent, suggesting a favorable mid-term kidney prognosis.
- A significant proportion of patients develop HTN at various time points, with a notable percentage having chronic HTN, often untreated.
Background:
To define the incidence of acute kidney injury (AKI), chronic kidney disease (CKD), and hypertension (HTN) in pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) over a recent 9-year period.
Methods:
This study is a retrospective cohort study of all pediatric patients diagnosed with ALL at Nationwide Children's Hospital from January 1, 2008, to December 31, 2016. Patient demographic and clinical data including serum creatinine and blood pressure were collected at diagnosis up to 9 years post diagnosis.
Results:
A total of 222 patients were identified for this study. The overall incidence of AKI in our cohort was high, with 101 subjects (45.5%, CI 38.8-52.3%) developing AKI at least once. CKD status could only be determined in 214 patients due to limited later GFR data. The incidence of CKD was low with only 5 of 214 patients developing CKD (2.3%, CI: 0.8-5.4%). The overall incidence of HTN at diagnosis was 45.6% (95% CI: 59.1-72%), and at 1 month post diagnosis was 65.8% (95% CI: 59.1-72.0%). Chronic HTN could only be determined in 216 patients due to limited blood pressure data. Chronic HTN was noted in 34.3% of patients (74/216, 95% CI: 28-41%).
Conclusions:
Among children with ALL, the incidence of AKI is relatively high at the time of diagnosis. However, development of CKD is relatively rare, suggesting good mid-term kidney prognosis. There is a high incidence of HTN at the time of diagnosis, 1 month post diagnosis, and chronic HTN that often goes untreated. A higher resolution version of the Graphical abstract is available as Supplementary information.
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