Adult survivors of childhood cancers who underwent certain chemotherapy treatments or kidney surgery were found to have worse kidney function that did not recover over time, which may put them at higher risk for premature renal failure, according to a study published in Cancer Epidemiology, Biomarkers & Prevention (2013;22:1736).
“This is the first longitudinal cohort study that takes into account multiple measurements of kidney function over time within the same patient to evaluate time trends in a large group of childhood cancer survivors with a long and nearly complete follow-up,” the lead author, Renée Mulder, PhD, research associate in the Department of Pediatric Oncology at Emma Children's Hospital/Academic Medical Center in Amsterdam, the Netherlands, said in a news release. The study was the first to show that kidney function in these patients did not recover and actually got worse, she added.
To determine kidney functionality, the researchers assessed glomerular function in 1,122 childhood cancer survivors at a median follow-up of 21 years after diagnosis who were at least 18 years old. The survivors treated with potentially nephrotoxic therapy had a significantly lower glomerular filtration rate and higher glomerular dysfunction probability up to 35 years after diagnosis compared with the survivors treated without nephrotoxic therapy.
Ifosfamide, cisplatin, and nephrectomy were found to be especially associated with worse glomerular function that persisted through the entire follow-up period. The data also showed that glomerular function deteriorated over time in all survivors, and that those treated with higher doses of cisplatin appeared to have higher deterioration rates compared with the other survivors.
Mulder noted via email that the research suggests that health care providers and survivors need be aware of the increased risk of symptomatic and asymptomatic kidney damage after nephrotoxic therapy because these patients are also at increased risk for developing comorbidities, such as cardiovascular disease.
Further studies are now needed to evaluate the predictive value of first assessment on the glomerular function over time, and on the longitudinal evaluation of other outcomes related to glomerular function (including proteinuria and hypertension), she added. “Another important step is to incorporate these study results into screening guidelines for childhood cancer survivors.”