Early and late renal adverse effects after potentially nephrotoxic treatment for childhood cancer

• Published in: Cochrane database of systematic reviews 2013-10 (10), p.CD008944
• Main Authors: Knijnenburg, Sebastiaan L, Mulder, Renée L, Schouten-Van Meeteren, Antoinette Y N, Bökenkamp, Arend, Blufpand, Hester, van Dulmen-den Broeder, Eline, Veening, Margreet A, Kremer, Leontien C M, Jaspers, Monique W M
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - adverse effects; Carboplatin - adverse effects; Child; Cisplatin - adverse effects; Glomerular Filtration Rate - drug effects; Glomerular Filtration Rate - physiology; Glomerular Filtration Rate - radiation effects; Humans; Hypertension - epidemiology; Hypertension - etiology; Hypophosphatemia - epidemiology; Hypophosphatemia - etiology; Ifosfamide - adverse effects; Magnesium Deficiency - epidemiology; Magnesium Deficiency - etiology; Nephrectomy - adverse effects; Proteinuria - epidemiology; Proteinuria - etiology; Radiotherapy - adverse effects; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - etiology; Risk Factors; Survivors
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD008944.pub2

Great improvements in diagnostics and treatment for malignant disease in childhood have led to a major increase in survival. However, childhood cancer survivors (CCS) are at great risk for developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is one of these known (acute) side effects of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate impairment, proteinuria, tubulopathy and hypertension. However, evidence about the long-term effects of these treatments on renal function remains inconclusive. To reduce the number of (long-term) nephrotoxic events in CCS, it is important to know the risk of, and risk factors for, early and late renal adverse effects, so that ultimately treatment and screening protocols can be adjusted. To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of and associated risk factors for renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with healthy controls or CCS treated without potentially nephrotoxic treatment. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2011), MEDLINE/PubMed (from 1945 to December 2011) and EMBASE/Ovid (from 1980 to December 2011). With the exception of case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment) in children and adults who were treated for a paediatric malignancy (aged 18 years or younger at diagnosis) with cisplatin, carboplatin, ifosfamide, radiation including the kidney region and/or a nephrectomy. Two review authors independently performed study selection, risk of bias assessment and data extraction using standardised data collection forms. Analyses were performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The search strategy identified 5504 studies, of which 5138 were excluded on the basis of title and/or abstract. The full-text screening of the remaining 366 articles resulted in the inclusion of 57 studies investigating the prevalence of and sometimes also risk factors for early and late renal adverse effects