Long-term risk of renal and urinary tract diseases in childhood cancer survivors: A population-based cohort study.
Childhood cancer has been associated with long-term risk of urinary tract diseases, but risk patterns remain to be comprehensively investigated. We analysed the lifetime risk of urinary tract diseases in survivors of childhood cancer in the Nordic countries.



We identified 32,519 one-year survivors of childhood cancer diagnosed since the 1940s and 1950s in the five Nordic cancer registries and selected 211,156 population comparisons of a corresponding age, sex, and country of residence from the national population registries. To obtain information on all first-time hospitalizations for a urinary tract disease, we linked all study subjects to the national hospital registry of each country. Relative risks (RRs) and absolute excess risks (AERs) and associated 95% confidence intervals (CIs) for urinary tract diseases among cancer survivors were calculated with the appropriate morbidity rates among comparisons as reference.



We observed 1645 childhood cancer survivors ever hospitalized for urinary tract disease yielding an RR of 2.5 (95% CI 2.4-2.7) and an AER of 229 (95% CI 210-248) per 100,000 person-years. The cumulative risk at age 60 was 22% in cancer survivors and 10% in comparisons. Infections of the urinary system and chronic kidney disease showed the highest excess risks, whereas survivors of neuroblastoma, hepatic and renal tumours experienced the highest RRs.



Survivors of childhood cancer had an excess risk of urinary tract diseases and for most diseases the risk remained elevated throughout life. The highest risks occurred following therapy of childhood abdominal tumours.
Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. Electronic address: bonnesen@dadlnet.dk.
Trine Gade
TG
Bonnesen
Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark.
Jeanette F
JF
Winther
Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Peter H
PH
Asdahl
Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark.
Sofie
S
de Fine Licht
Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark.
Thorgerdur
T
Gudmundsdottir
Pediatric Oncology and Hematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden.
Anna
A
Sällfors Holmqvist
Finnish Cancer Registry, Pieni Roobertinkatu 9, 00130 Helsinki, Finland; Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Laura-Maria
LM
Madanat-Harjuoja
Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland; The Icelandic Cancer Registry, Skogarhlid 9, PO Box 5420, 125 Reykjavik, Iceland.
Laufey
L
Tryggvadottir
Cancer Registry of Norway, P.O. Box 5313, Majorstuen, Oslo, Norway.
Finn
F
Wesenberg
Department of Nephrology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Henrik
H
Birn
Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark.
Jørgen H
JH
Olsen
Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Henrik
H
Hasle
D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data*; D014570:Urologic Diseases / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
Childhood cancer; Late complications; Renal diseases; Survivorship; Urinary tract diseases