TOPLINE:

Acute kidney injury (AKI) affected more than one third of paediatric patients undergoing cancer treatment, with drugs such as ifosfamide, amphotericin B, busulfan, and acyclovir being strongly associated with an increased risk. Patients who experienced AKI during therapy were more likely to develop chronic kidney disease (CKD) at 1 year after completing treatment.

METHODOLOGY:

• Researchers investigated the incidence of AKI, the impact of nephrotoxic medications, and the association between AKI and subsequent CKD in a retrospective national cohort of 1525 paediatric patients with cancer (median age, 5.9 years; 55% boys) treated at a tertiary centre between 2015 and 2021.
• Eligible patients were those diagnosed with cancer before the age of 19 years who had no prior AKI episodes or renal replacement therapy before initiating cancer treatment.
• AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes criteria.
• The development of CKD — defined as an estimated glomerular filtration rate (eGFR) below 90 mL/min/1.73 m² for more than 3 months — was assessed in 1159 patients with at least 1 year of follow‐up after completing cancer therapy.
• This study flagged 51 drugs as potentially nephrotoxic and considered a patient exposed if any of these agents were administered within the 14 days prior to an AKI episode.

TAKEAWAY:

• Among the 1525 patients, 37.4% experienced at least one AKI episode during treatment, with 59% having one episode, 24% developing two episodes, and 17% experiencing three or more episodes.
• The highest incidence of AKI was observed among patients with acute myeloid leukaemia, non-Hodgkin lymphoma, and kidney tumours.
• Ifosfamide showed the strongest association with the risk for AKI (cause-specific hazard ratio [HR], 2.99; 95% CI, 2.30-3.88), followed by amphotericin B (cause-specific HR, 2.08; 95% CI, 1.53-2.81), busulfan (cause-specific HR, 1.53; 95% CI, 1.03-2.25), and acyclovir (cause-specific HR, 1.53; 95% CI, 1.03-2.26).
• At 1 year after the completion of cancer treatment, 13.6% of patients had CKD with an eGFR below 90 mL/min/1.73 m²; multiple AKI episodes significantly increased the risk for CKD (odds ratio [OR], 15.90; 95% CI, 10.44-24.20), whereas a single AKI episode showed a lower but still elevated risk (OR, 2.60; 95% CI, 1.62-4.15).

IN PRACTICE:

"Therefore, awareness is important and monitoring of renal function at diagnosis, during and after treatment is strongly recommended to prevent AKI and CKD as much as possible. In addition, development of intervention strategies to avoid early and long term kidney injury is warranted in children with cancer," the authors wrote.

SOURCE:

This study was led by Paulien A.M.A. Raymakers-Janssen, Department of Pediatric Intensive Care, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands. It was published online on August 22, 2025, in Nephrology Dialysis Transplantation.

LIMITATIONS:

This study focused primarily on nephrotoxic medications as predictors of AKI, potentially overlooking other patient- and disease-specific variables such as tumour type, hematopoietic stem cell transplantation, ICU admission, nephrectomy, comorbidities, and illness severity. Additionally, cumulative medication dosages were not included in the analysis. The use of serum creatinine levels as the sole indicator of AKI may have underestimated its incidence as creatinine levels can remain unchanged until more than half of the nephrons have lost their function.

DISCLOSURES:

No funding sources were reported for this study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.