However, CCS are at risk of developing adverse effects as a result of their cancer treatment, including adverse effects on the kidneys. Improvements in diagnostics and treatment for childhood cancer has resulted in a major increase in survival.
This review evaluated how common (the prevalence), and what might cause (the risk factors), early and late adverse effects (side effects), of the kidney in childhood cancer survivors (CCS). Until more evidence becomes available, CCS should preferably be enrolled into long‐term follow‐up programmes to monitor their renal function and blood pressure.Įarly and late adverse effects on the kidney after treatment for childhood cancer Next to research concerning known nephrotoxic therapies, exploring nephrotoxicity after new therapeutic agents is advised for future studies. In addition, these studies should deploy multivariable risk factor analyses to correct for possible confounding. Future studies should focus on adequate study designs and reporting, including large prospective cohort studies with adequate control groups when possible. With currently available evidence, it was not possible to draw solid conclusions regarding the prevalence of, and treatment‐related risk factors for, specific adverse renal effects. The prevalence of adverse renal effects after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region, nephrectomy, or any combination of these, ranged from 0% to 84% depending on the study population, received treatment combination, reported outcome measure, follow‐up duration and methodological quality. Treatment‐related risk factors were abdominal radiotherapy and TBI, but studies were inconsistent.īecause of the profound heterogeneity of the studies, it was not possible to perform meta‐analyses. Three non‐eligible studies showed that a higher body mass index increased the risk of hypertension. A non‐eligible study also found long follow‐up time as risk factor. Risk factors reported by one eligible study were older age at screening and abdominal radiotherapy. The prevalence of hypertension ranged from 0% to 50% in 2464 participants (30/52 studies). Carboplatin, nephrectomy and follow‐up time were other reported risk factors. Both non‐eligible studies investigating risk factors identified cisplatin as a risk factor. One non‐eligible study investigated risk factors for hypophosphataemia, but could not find any association.įour out of 52 studies, including 128 CCS, assessed the prevalence of hypomagnesaemia, which ranged between 13.2% and 28.6%. Prevalence ranged between 0% and 36.8% for hypophosphataemia in 287 participants, and from 0% to 62.5% for impaired TPR in 246 participants. However, studies were contradictory and incomparable.Įleven out of 52 studies assessed hypophosphataemia or tubular phosphate reabsorption (TPR), or both. Risk factors, analysed by three non‐eligible studies, included HD cisplatin, (HD) ifosfamide, TBI, and a combination of nephrectomy and abdominal radiotherapy.
Twenty‐two out of 52 studies, including 851 participants, studied proteinuria, which was present in 3.5% to 84% of participants. In addition, two non‐eligible studies showed an association of a longer follow‐up period with glomerular dysfunction. The majority also reported cisplatin as a risk factor. Four non‐eligible studies assessing a total cohort of CCS, found nephrectomy and (high‐dose (HD)) ifosfamide as risk factors for decreased GFR. One eligible study reported an increased risk of glomerular dysfunction after concomitant treatment with aminoglycosides and vancomycin in CCS receiving total body irradiation (TBI).
Of these 52 studies, 36 studied a decreased (estimated) GFR, including at least 432 CCS, and found it was present in 0% to 73.7% of participants. Seven out of 52 studies, including 244 participants, reported the prevalence of chronic kidney disease, which ranged from 2.4% to 32%. This variation may be due to diversity of included malignancies, received treatments, reported outcome measures, follow‐up duration and the methodological quality of available evidence. The prevalence of adverse renal effects ranged from 0% to 84%. The 52 studies evaluating the prevalence of renal dysfunction included 13,327 participants of interest, of whom at least 4499 underwent renal function testing. In total, we included 61 studies 46 for prevalence, six for both prevalence and risk factors, and nine not meeting the inclusion criteria, but assessing risk factors. Apart from the remaining 37 studies included from the original review, the search resulted in the inclusion of 24 new studies.
0 kommentar(er)
