Childhood Cancer Survivors: Long Term Kidney Function Decline

Renée L. Mulder, PhD Department of Pediatric Oncology Emma Children's Hospital / Academic Medical Center 1100 DD Amsterdam The Interview with:
Renée L. Mulder, PhD
Department of Pediatric Oncology
Emma Children’s Hospital / Academic Medical Center
1100 DD Amsterdam The Netherlands What are the main findings of the study?

Dr. Mulder: The glomerular function of childhood cancer survivors treated with nephrotoxic therapy declines very soon after treatment and does not recover. The glomerular function declines over time. This decline is comparable to survivors treated without nephrotoxic therapy. Were any of the findings unexpected?

Dr. Mulder: We showed that the damage to the kidneys occurred during or early after nephrotoxic cancer treatment (<5 years since diagnosis). After that period the glomerular function showed a stable decline, comparable to the decline in survivors treated without nephrotoxic therapy. This implicates that the high risk groups can be identified within the first years of cancer treatment. We were surprised by the fact that the kidney function did neither recover nor showed a worse decline more than 5 years after childhood cancer diagnosis. What should clinicians and patients take away from your report?

Dr. Mulder: As glomerular function continues to decline, childhood cancer survivors treated with nephrotoxic therapy, especially ifosfamide, higher doses of cisplatin and nephrectomy, are at risk for kidney damage. Special attention is warranted as the decline occurs very soon which poses this group at early risk of chronic kidney failure.

Health care providers and survivors should be aware of this increased risk of early (a)symptomatic kidney damage after nephrotoxic treatment for childhood cancer, because these patients are also at increased risk for developing co-morbidities, such as cardiovascular disease. Identification of childhood cancer survivors at risk for kidney damage can be performed five years after the start of nephrotoxic treatment. What recommendations do you have for future research as a result of this study?

Dr. Mulder: Future studies should 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.

Another important step is to incorporate our study results into these screening guidelines for childhood cancer survivors. The International Guideline Harmonization Group for Late Effects of Childhood Cancer is a unique endeavor for developing worldwide guidelines for the long-term follow-up of childhood cancer survivors.


Glomerular Function Time Trends in Long-Term Survivors of Childhood Cancer: A Longitudinal Study

Renée L. Mulder, Sebastiaan L. Knijnenburg, Ronald B. Geskus, Elvira C. van Dalen, Helena J.H. van der Pal, Caro C.E. Koning, Antonia H. Bouts, Huib N. Caron, and Leontien C.M. Kremer

Cancer Epidemiol Biomarkers Prev Published OnlineFirst September 24, 2013; doi:10.1158/1055-9965.EPI-13-0036

Last Updated on September 25, 2013 by Marie Benz MD FAAD