Nephrotoxicity Surveillance for Childhood and Young Adult Survivors of Cancer: Recommendations From the International Late Effects of Childhood Cancer Guideline Harmonization Group
Abstract
PURPOSE Childhood, adolescent, and young adult (CAYA) survivors of cancer are at risk of nephrotoxicity. Surveillance guidelines are important for timely diagnosis and treatment of these survivors, which could slow the progression to higher stages of kidney dysfunction. METHODS The International Late Effects of Childhood Cancer Guideline Harmonization Group established a multidisciplinary panel of 34 experts from 11 countries. The panel performed systematic literature reviews for articles published between 1990 and June 2023, graded the evidence using Grading of Recommendations Assessment, Development, and Evaluation methodology, and formulated recommendations based on evidence, clinical judgment, and consideration of benefits and harms of surveillance. Recommendations were critically appraised by two independent external experts and patient representatives. RESULTS Glomerular dysfunction surveillance is recommended every 2-5 years for survivors treated with ifosfamide, cisplatin, abdominal radiotherapy, total body irradiation, or nephrectomy and is reasonable after carboplatin treatment. We recommend screening for glomerular dysfunction using an estimated glomerular filtration rate (eGFR) equation that includes serum creatinine, preferably combined with serum cystatin C if available. Tubular dysfunction surveillance is recommended once at entry into long-term follow-up and with follow-up as clinically indicated for survivors treated with ifosfamide and is reasonable after cisplatin treatment. CONCLUSION These recommendations inform routine, uniform long-term follow-up care for CAYA survivors of cancer at risk of nephrotoxicity.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (34)
Esmee C.M. Kooijmans
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
Renée L. Mulder
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
Stephen D. Marks
Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
Vesna Pavasovic
Department of Malignant Paediatric Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
Shveta S. Motwani
Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
Thomas Walwyn
Department of Oncology, Haematology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA
Nicholas G. Larkins
Discipline of Paediatrics, Medical School, University of Western Australia, Perth, WA, Australia
Jarmila Kruseová
Louis S. Constine
Wilmot Cancer Institute, Rochester, NY
W. Hamish Wallace
The University of Edinburgh, Edinburgh, Scotland
Daniel M. Green
St. Jude Children's Research Hospital, Memphis, TN
Arend Bökenkamp
Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Helena J.H. van der Pal
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
Marry M. van den Heuvel-Eibrink
Lars Hjorth
Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
Liv Andrés-Jensen
Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
Edit Bardi
St Anna Childrens Hospita and St Anna Children's Cancer Research Institute, Vienna, Austria
Elvira C. van Dalen
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
Charlotte Demoor-Goldschmidt
Department of Pediatric Oncology, University Hospital of Angers, Angers, France
Kerri Becktell
Division of Pediatric Oncology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
Marika Grönroos
Department of Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
Kathleen Kieran
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA
Denitza Mironova
Department of Oncology, Haematology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA
Monica Terenziani
Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Margreet A. Veening
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
Jakub Zieg
Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
Songul Onder
Department of Nephrology, University of Tennessee, School of Medicine, Memphis, TN
Ali Mirza Onder
Department of Pediatric Nephrology, Nemours Children's Hospital, Wilmington, DE
Jonathan C. Routh
Department of Urology, Duke University School of Medicine, Durham, NC
Joel Thompson
1University of Missouri-Kansas City School of Medicine, Kansas City, United States
Melissa M. Hudson
Leontien C.M. Kremer
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
Roderick Skinner
Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
Matthew J. Ehrhardt