ESPN 53rd Annual Meeting

ESPN 2021


 
OUTCOME OF PEDIATRIC PATIENTS STARTING KIDNEY REPLACEMENT THERAPY AFTER CANCER TREATMENT- ESPN/ERA-EDTA REGISTRY DATA
HENNA PUUSAARI 1 HENNA PUUSAARI 2 MARJOLEIN BONTHUIS 3 JEROME HARAMBAT 4 ENRICO VIDAL 5 MANISH SINHA 6 KITTY JAGER 3 TIMO JAHNUKAINEN 2

1- TAMPERE UNIVERSITY HOSPITAL, DEPARTMENT OF PEDIATRICS, PEDIATRIC NEPHROLOGY, TAMPERE, FINLAND
2- DEPARTMENT OF PEDIATRIC NEPHROLOGY AND TRANSPLANTATION, CHILDREN’S HOSPITAL, HELSINKI UNIVERSITY HOSPITAL AND UNIVERSITY OF HELSINKI, HELSINKI, FINLAND
3- ESPN/ERA-EDTA REGISTRY, DEPARTMENT OF MEDICAL INFORMATICS, AMSTERDAM UMC, UNIVERSITY OF AMSTERDAM, AMSTERDAM PUBLIC HEALTH RESEARCH INSTITUTE, AMSTERDAM, THE NETHERLANDS
4- DEPARTMENT OF PEDIATRICS, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX POPULATION HEALTH RESEARCH CENTER UMR 1219, UNIVERSITY OF BORDEAUX, BORDEAUX FRANCE
5- DIVISION OF PEDIATRICS, DEPARTMENT OF MEDICINE, UNIVERSITY OF UDINE, UDINE, ITALY.
6- KINGS COLLEGE LONDON; DEPARTMENT OF PAEDIATRIC NEPHROLOGY, EVELINA LONDON CHILDRENS HOSPITAL, LONDON, UK.
 
Introduction:

 Survival of pediatric cancer patients has improved during recent decades, leading to an increased number of children with kidney dysfunction caused by the tumor itself or by cancer treatments, like cytostatic and irradiation therapy. Only few studies reporting outcomes of pediatric cancer patients starting kidney replacement therapy (KRT) are available. Therefore, we aimed to evaluate long-term patient and graft survival in pediatric KRT patients with a malignancy history. 

Material and methods:

 Data were collected from the ESPN/ERA-EDTA Registry. All patients younger than 20 years of age starting KRT after malignancy treatment between 1980 and 2018 were included. Cancer patients were divided in two groups: (group 1) malignancy as a primary renal disease (PRD) and (group 2) history of malignancy but another PRD. Two non-cancer controls were selected for every patient matched on age, sex, year of KRT and country macro-economics. 

Results:

 130 patients in group 1 and 108 patients in group 2 were identified. Patients in group 1 were significantly younger (4.4; 1.7-8.7 years) at start of KRT than patients in group 2 (13.0; 6.1-17.5 years). The median time to kidney transplantation (KT) was longer in the malignancy groups than in the control groups. Five-year access to KT was 72.4%, 76.8%, 66.5% and 78.2% in group 1, their controls (group 3), group 2 and their controls (group 4), respectively. The 5-year mortality was higher in among malignancy patients: 14.7% (group 1), 10.7% (group 2), 6.6% (group 3), and 6.8% (group 4). In group 1, 36.4% of deaths were caused by the malignancy itself, whereas infection predominated in group 3.

Conclusions:

 Five-year mortality was higher in malignancy groups, mainly due to mortality caused by malignancies. Patients with malignancies spent longer time on dialysis before receiving KT, but access to KT was much more similar at 5-year follow-up.