Acute kidney injury during treatment of pediatric brain tumors: a retrospective analysis of survivors.

BACKGROUND: Pediatric cancer survivors are at risk of short- and long-term complications from cancer treatment, including acute kidney injury (AKI) and chronic kidney disease (CKD). Our aims were to assess AKI incidence, examine potential risk factors for AKI during pediatric central nervous system (CNS) tumor treatment, and evaluate for kidney function impairment in survivorship. We hypothesized that any chemotherapy exposure and burden would be associated with higher risk of AKI. METHODS: We reviewed medical records of pediatric CNS tumor survivors treated between 2007 and 2015. The primary outcome was AKI frequency during cancer treatment. Secondary outcomes were severe AKI (sAKI) occurrence during treatment and presence of chronic kidney injury markers (estimated glomerular filtration rate <90 ml/min/1.73m2 or proteinuria) 5+ years beyond treatment completion. RESULTS: 123 patients received CNS tumor treatment during the study period. Out of 41 patients with sufficient serum creatinine (SCr) data available to assess for AKI, 12 had AKI. Chemotherapy exposure was associated with a higher AKI incidence. Fifty-six percent of patients had chronic kidney impairment during survivorship. CONCLUSION: Acute and chronic kidney injury are common in patients with CNS tumors, but detection is limited by heterogeneity of tumor type and adequate SCr availability. IMPACT: Acute kidney injury (AKI) is common during treatment of pediatric tumors of the central nervous system. AKI detection is limited by low availability of adequate serum creatinine measurements in high-risk patients. This longitudinal cohort links AKI presence during cancer treatment with chronic kidney disease during survivorship. Identifying AKI as a CKD risk factor can inform preventive measures and improve monitoring strategies.