title: Renal dysfunction and elevated blood pressure in long-term childhood cancer survivors.
abstract: OBJECTIVE
  Little is known about renal function and blood pressure (BP) in long-term childhood cancer survivors. This cross-sectional study evaluated prevalence of these outcomes and associated risk factors in long-term childhood cancer survivors at their first visit to a specialized outpatient clinic.
  
  
  METHODS
  Estimated GFR; percentages of patients with albuminuria, hypomagnesemia, and hypophosphatemia; and BP were assessed in 1442 survivors ≥5 years after diagnosis. Multivariable logistic regression analyses were used to estimate effect of chemotherapy, nephrectomy, and radiation therapy on the different outcomes.
  
  
  RESULTS
  At a median age of 19.3 years (interquartile range, 15.6-24.5 years), 28.1% of all survivors had at least one renal adverse effect or elevated BP. The median time since cancer diagnosis was 12.1 years (interquartile range, 7.8-17.5 years). High BP and albuminuria were most prevalent, at 14.8% and 14.5%, respectively. Sixty-two survivors (4.5%) had an estimated GFR <90 ml/min per 1.73 m(2). Survivors who had undergone nephrectomy had the highest risk for diminished renal function (odds ratio, 8.6; 95% confidence interval [CI], 3.4-21.4). Combined radiation therapy and nephrectomy increased the odds of having elevated BP (odds ratio, 4.92; 95% CI, 2.63-9.19), as did male sex, higher body mass index, and longer time since cancer treatment.
  
  
  CONCLUSIONS
  Almost 30% of survivors had renal adverse effects or high BP. Therefore, monitoring of renal function in high-risk groups and BP in all survivors may help clinicians detect health problems at an early stage and initiate timely therapy to prevent additional damage.
authors: Department of Pediatric Oncology, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands. S.L.Knijnenburg@amc.uva.nl
authors: Sebastiaan L
authors: SL
authors: Knijnenburg
authors: Monique W
authors: MW
authors: Jaspers
authors: Helena J
authors: HJ
authors: van der Pal
authors: Antoinette Y
authors: AY
authors: Schouten-van Meeteren
authors: Antonia H
authors: AH
authors: Bouts
authors: Jan A
authors: JA
authors: Lieverst
authors: Arend
authors: A
authors: Bökenkamp
authors: Caro C E
authors: CC
authors: Koning
authors: Foppe
authors: F
authors: Oldenburger
authors: James C H
authors: JC
authors: Wilde
authors: Flora E
authors: FE
authors: van Leeuwen
authors: Huib N
authors: HN
authors: Caron
authors: Leontien C
authors: LC
authors: Kremer
mesh_terms: D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology; D000554:Ambulatory Care Facilities; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy*; D009392:Nephrectomy / Q000009:adverse effects; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011878:Radiotherapy / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult