Lam Suet Ying, Chan Eugene Yu-Hin, Cheng Frankie Wai Tso, Ma Alison Lap Tak, Ha Shau Yin
Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong.
Haematology and Oncology Centre, Department of Paediatric and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon City, Hong Kong.
Pediatr Nephrol. 2023 Nov;38(11):3823-3833. doi: 10.1007/s00467-023-06010-z. Epub 2023 May 23.
In onco-nephrology, data on acute kidney injury (AKI) among children with haematological malignancies are scarce.
A retrospective cohort study of all patients in Hong Kong diagnosed with haematological malignancies from 2019 to 2021 before 18 years of age, was conducted to investigate the epidemiology, risk factors and clinical outcomes of AKI during the first year of treatment. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
We included 130 children with haematological malignancy at median age of 9.4 years (IQR, 3.9-14.1). Of these patients, 55.4% were acute lymphoblastic leukemia (ALL), 26.9% were lymphoma and 17.7% were acute myeloid leukemia (AML). Thirty-five patients (26.9%) developed 41 AKI episodes during the first year of diagnosis, corresponding to 32 episodes per 100-patient-year. A total of 56.1% and 29.2% of the AKI episodes occurred during induction and consolidation chemotherapy respectively. Septic shock (n = 12, 29.2%) was the leading cause of AKI; 21 episodes (51.2%) were stage 3 AKI; 12 episodes (29.3%) were stage 2 AKI; and 6 patients required continuous kidney replacement therapies. Tumor lysis syndrome and impaired baseline kidney function were significantly associated with AKI on multivariate analysis (P = 0.01). History of AKI was associated with chemotherapy postponement (37.1% vs. 16.8%, P = 0.01), worse 12-month patient survival (77.1% vs. 94.7%, log rank P = 0.002) and lower disease remission rate at 12-month (68.6% vs. 88.4%, P = 0.007), compared to patients without AKI.
AKI is a common complication during treatment of haematological malignancies which is associated with worse treatment outcomes. A regular and dedicated surveillance program for at-risk patients should be studied in children with haematological malignancies for prevention and early detection of AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
在肿瘤肾脏病学领域，关于血液系统恶性肿瘤患儿急性肾损伤（AKI）的数据较为匮乏。
对2019年至2021年期间香港所有18岁以下诊断为血液系统恶性肿瘤的患者进行回顾性队列研究，以调查治疗第一年期间AKI的流行病学、危险因素及临床结局。AKI根据肾脏病改善全球预后（KDIGO）标准进行定义。
我们纳入了130例血液系统恶性肿瘤患儿，中位年龄为9.4岁（四分位间距，3.9 - 14.1岁）。其中，55.4%为急性淋巴细胞白血病（ALL），26.9%为淋巴瘤，17.7%为急性髓系白血病（AML）。35例患者（26.9%）在诊断后的第一年发生了41次AKI事件，相当于每100患者年32次事件。分别有56.1%和29.2%的AKI事件发生在诱导化疗和巩固化疗期间。感染性休克（n = 12，29.2%）是AKI的主要原因；21次事件（51.2%）为3期AKI；12次事件（29.3%）为2期AKI；6例患者需要持续肾脏替代治疗。多因素分析显示，肿瘤溶解综合征和基线肾功能受损与AKI显著相关（P = 0.01）。与无AKI的患者相比，有AKI病史与化疗推迟相关（37.1%对16.8%，P = 0.01），12个月时患者生存率更低（77.1%对94.7%，对数秩检验P = 0.002），且12个月时疾病缓解率更低（68.6%对88.4%，P = 0.007）。
AKI是血液系统恶性肿瘤治疗期间的常见并发症，与较差的治疗结局相关。对于血液系统恶性肿瘤患儿，应研究针对高危患者的定期且专门的监测方案，以预防和早期发现AKI。更高分辨率的图形摘要版本可作为补充信息获取。
