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Defining kidney outcomes in children with acute lymphoblastic leukemia in the modern era

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Abstract

Background

To define the incidence of acute kidney injury (AKI), chronic kidney disease (CKD), and hypertension (HTN) in pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) over a recent 9-year period.

Methods

This study is a retrospective cohort study of all pediatric patients diagnosed with ALL at Nationwide Children’s Hospital from January 1, 2008, to December 31, 2016. Patient demographic and clinical data including serum creatinine and blood pressure were collected at diagnosis up to 9 years post diagnosis.

Results

A total of 222 patients were identified for this study. The overall incidence of AKI in our cohort was high, with 101 subjects (45.5%, CI 38.8–52.3%) developing AKI at least once. CKD status could only be determined in 214 patients due to limited later GFR data. The incidence of CKD was low with only 5 of 214 patients developing CKD (2.3%, CI: 0.8–5.4%). The overall incidence of HTN at diagnosis was 45.6% (95% CI: 59.1–72%), and at 1 month post diagnosis was 65.8% (95% CI: 59.1–72.0%). Chronic HTN could only be determined in 216 patients due to limited blood pressure data. Chronic HTN was noted in 34.3% of patients (74/216, 95% CI: 28–41%).

Conclusions

Among children with ALL, the incidence of AKI is relatively high at the time of diagnosis. However, development of CKD is relatively rare, suggesting good mid-term kidney prognosis. There is a high incidence of HTN at the time of diagnosis, 1 month post diagnosis, and chronic HTN that often goes untreated.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Pediatrics, Division Nephrology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27705, USA

    Reeti Kumar

  2. Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant, Nationwide Children’s Hospital, Columbus, OH, 432015, USA

    Suzanne Reed & Joseph R. Stanek

  3. Department of Pediatrics, Division of Nephrology, Nationwide Children’s Hospital, Columbus, OH, 432015, USA

    John D. Mahan

Authors
  1. Reeti Kumar
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  2. Suzanne Reed
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  3. Joseph R. Stanek
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  4. John D. Mahan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Reeti Kumar, Suzanne Reed, Joseph R Stanek, and John D. Mahan. The first draft of the manuscript was written by Reeti Kumar, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Reeti Kumar.

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Ethics approval

Ethical approval was waived by the local Ethics Committee of Nationwide Children’s Hospital in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

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The authors declare no competing interests.

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Kumar, R., Reed, S., Stanek, J.R. et al. Defining kidney outcomes in children with acute lymphoblastic leukemia in the modern era. Pediatr Nephrol 37, 2119–2126 (2022). https://doi.org/10.1007/s00467-021-05402-3

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  • DOI: https://doi.org/10.1007/s00467-021-05402-3

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