Background and objectives Because little is known about long-term treatment-related nephrotoxicity, the aim was to determine risk factors for renal impairment long after childhood cancer treatment. Design, setting, participants, & measurements Data from 763 adult childhood cancer survivors (414 men) were obtained during regular visits at the late-effects clinic between 2003 and 2009. Median follow-up time was 18.3 years (range=5.0-58.2). Glomerular function was assessed by estimated GFR (using the Modification of Diet in Renal Disease formula), urinary albumin creatinine ratio, and tubular function by urinary β2-microglobulin creatinine ratio. The associationwith treatment factorswas analyzedwith covariance analysis for estimated GFR and logistic regression for urinary albumin and urinary β2-microglobulin creatinine ratios. Results Survivors treated with nephrectomy and abdominal irradiation had significantly lower estimated GFR than survivors not treated with nephrectomy/abdominal irradiation (estimated mean=90 ml/min per 1.73 m2versus 106, P<0.001). Estimated GFR was significantly lower in survivors after treatment with high-dose ifosfamide (88 versus 98, P=0.02) and high-dose cisplatin (83 versus 101, P=0.004) compared with survivors not treated with these regimen. Nephrectomy combined with abdominal radiotherapy (odds ratio=3.14, 95% confidence interval=1.02; 9.69) and high-dose cisplatin (odds ratio=5.19, 95% confidence interval=1.21; 22.21) was associated with albuminuria. High-dose ifosfamide (odds ratio=6.19, 95% confidence interval=2.45; 15.67) was associated with increased urinary β2-microglobulin creatinine ratio. Hypertension was present in 23.4% of survivors and 31.4% of renal tumor survivors. Conclusions Treatment with unilateral nephrectomy, abdominal radiotherapy, cisplatin, and ifosfamide was associated with lower estimated GFR. Persisting tubular damage was related to ifosfamide treatment.

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Keywords adult, article, blood pressure, childhood cancer, confidence interval, controlled study, disease association, drug megadose, female, follow up, glomerulus filtration rate, human, hypertension, irradiation, kidney tubule function, major clinical study, male, microalbuminuria, nephrectomy, nephrotoxicity, retrospective study, risk factor
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Journal Clinical Journal of the American Society of Nephrology
Dekkers, I.A, Blijdorp, K, Cransberg, K, Pluijm, S.M, Pieters, R, Neggers, S.J.C.M.M, & van den Heuvel-Eibrink, M.M. (2013). Long-term nephrotoxicity in adult survivors of childhood cancer. Clinical Journal of the American Society of Nephrology, 8(6), 922–929. doi:10.2215/CJN.09980912