Department of Respiratory Medicine, UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Department of Pharmacology-Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia.
Pediatr Nephrol. 2023 Feb;38(2):593-604. doi: 10.1007/s00467-022-05632-z. Epub 2022 Jun 24.
Various definitions used to describe cisplatin nephrotoxicity potentially lead to differences in determination of risk factors. This study evaluated incidence of kidney injury according to commonly used and alternative definitions in two cohorts of children who received cisplatin.
This retrospective cohort study included children from Vancouver, Canada (one center), and Mexico City, Mexico (two centers), treated with cisplatin for a variety of solid tumors. Serum creatinine-based definitions (KDIGO and Pediatric RIFLE (pRIFLE)), electrolyte abnormalities consisted of hypokalemia, hypophosphatemia and hypomagnesemia (based on NCI-CTCAE v5), and an alternative definition (Alt-AKI) were used to describe nephrotoxicity. Incidence with different definitions, definitional overlap, and inter-definition reliability was analyzed.
In total, 173 children (100 from Vancouver, 73 from Mexico) were included. In the combined cohort, Alt-AKI criteria detected more patients with cisplatin nephrotoxicity compared to pRIFLE and KDIGO criteria (82.7 vs. 63.6 vs. 44.5%, respectively). Nephrotoxicity and all electrolyte abnormalities were significantly more common in Vancouver cohort than in Mexico City cohort except when using KDIGO definition. The most common electrolyte abnormalities were hypomagnesemia (88.9%, Vancouver) and hypophosphatemia (24.2%, Mexico City). The KDIGO definition provided highest overlap of cases in Vancouver (100%), Mexico (98.6%), and the combined cohort (99.4%). Moderate overall agreement was found among Alt-AKI, KDIGO, and pRIFLE definitions (κ = 0.18, 95% CI 0.1-0.27) in which KDIGO and pRIFLE showed moderate agreement (κ = 0.48, 95% CI 0.36-0.60).
Compared to pRIFLE and KDIGO criteria, Alt-AKI criteria detected more patients with cisplatin nephrotoxicity. pRIFLE is more sensitive to detect not only actual kidney injury but also patients at risk of cisplatin nephrotoxicity, while KDIGO seems more useful to detect clinically significant kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.
用于描述顺铂肾毒性的各种定义可能导致危险因素确定方面的差异。本研究评估了两种接受顺铂治疗的儿童队列中，根据常用和替代定义发生肾损伤的情况。
这是一项回顾性队列研究，纳入了来自加拿大温哥华（一个中心）和墨西哥城（两个中心）的接受各种实体瘤治疗的儿童。基于血清肌酐的定义（KDIGO 和儿科 RIFLE（pRIFLE））、电解质异常包括低钾血症、低磷血症和低镁血症（基于 NCI-CTCAE v5）和替代定义（Alt-AKI）用于描述肾毒性。分析了不同定义的发生率、定义重叠和定义间可靠性。
共纳入 173 名儿童（100 名来自温哥华，73 名来自墨西哥城）。在合并队列中，与 pRIFLE 和 KDIGO 标准相比，Alt-AKI 标准检测到更多顺铂肾毒性患者（分别为 82.7%、63.6%和 44.5%）。除 KDIGO 定义外，肾毒性和所有电解质异常在温哥华队列中比在墨西哥城队列中更为常见。最常见的电解质异常是低镁血症（88.9%，温哥华）和低磷血症（24.2%，墨西哥城）。KDIGO 定义在温哥华（100%）、墨西哥城（98.6%）和合并队列（99.4%）中提供了最高的病例重叠。在 Alt-AKI、KDIGO 和 pRIFLE 定义之间发现了中度总体一致性（κ=0.18，95%CI 0.1-0.27），其中 KDIGO 和 pRIFLE 显示中度一致性（κ=0.48，95%CI 0.36-0.60）。
与 pRIFLE 和 KDIGO 标准相比，Alt-AKI 标准检测到更多顺铂肾毒性患者。pRIFLE 不仅更敏感地检测到实际的肾损伤，而且还检测到顺铂肾毒性的高危患者，而 KDIGO 似乎更有助于检测到有临床意义的肾损伤。可在补充资料中获取高分辨率版本的图表摘要。
