Department of Pediatric Oncology, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands.
Clin J Am Soc Nephrol. 2012 Sep;7(9):1416-27. doi: 10.2215/CJN.09620911. Epub 2012 Jul 19.
Little is known about renal function and blood pressure (BP) in long-term childhood cancer survivors. This cross-sectional study evaluated prevalence of these outcomes and associated risk factors in long-term childhood cancer survivors at their first visit to a specialized outpatient clinic.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Estimated GFR; percentages of patients with albuminuria, hypomagnesemia, and hypophosphatemia; and BP were assessed in 1442 survivors ≥5 years after diagnosis. Multivariable logistic regression analyses were used to estimate effect of chemotherapy, nephrectomy, and radiation therapy on the different outcomes.
At a median age of 19.3 years (interquartile range, 15.6-24.5 years), 28.1% of all survivors had at least one renal adverse effect or elevated BP. The median time since cancer diagnosis was 12.1 years (interquartile range, 7.8-17.5 years). High BP and albuminuria were most prevalent, at 14.8% and 14.5%, respectively. Sixty-two survivors (4.5%) had an estimated GFR <90 ml/min per 1.73 m(2). Survivors who had undergone nephrectomy had the highest risk for diminished renal function (odds ratio, 8.6; 95% confidence interval [CI], 3.4-21.4). Combined radiation therapy and nephrectomy increased the odds of having elevated BP (odds ratio, 4.92; 95% CI, 2.63-9.19), as did male sex, higher body mass index, and longer time since cancer treatment.
Almost 30% of survivors had renal adverse effects or high BP. Therefore, monitoring of renal function in high-risk groups and BP in all survivors may help clinicians detect health problems at an early stage and initiate timely therapy to prevent additional damage.
对于长期儿童癌症幸存者的肾功能和血压（BP）知之甚少。本横断面研究评估了这些结果的患病率以及在首次就诊于专门门诊的长期儿童癌症幸存者中的相关危险因素。
设计、设置、参与者和测量方法：评估了 1442 名诊断后≥5 年的幸存者的估计肾小球滤过率（eGFR）；白蛋白尿、低镁血症和低磷血症的患者百分比；以及 BP。多变量逻辑回归分析用于估计化疗、肾切除术和放射治疗对不同结果的影响。
在中位数年龄为 19.3 岁（四分位距，15.6-24.5 岁）的所有幸存者中，有 28.1%至少有一个肾脏不良事件或升高的 BP。自癌症诊断以来的中位时间为 12.1 年（四分位距，7.8-17.5 年）。高血压和白蛋白尿最常见，分别为 14.8%和 14.5%。有 62 名幸存者（4.5%）的估计肾小球滤过率<90 ml/min/1.73 m²。接受过肾切除术的幸存者肾功能下降的风险最高（优势比，8.6；95%置信区间 [CI]，3.4-21.4）。放射治疗联合肾切除术增加了高血压的几率（优势比，4.92；95%CI，2.63-9.19），男性、更高的体重指数和更长的癌症治疗后时间也是如此。
近 30%的幸存者有肾脏不良事件或高血压。因此，对高危人群的肾功能和所有幸存者的 BP 进行监测可能有助于临床医生早期发现健康问题并及时开始治疗，以防止进一步的损害。
