CC BY 4.0 · Brazilian Journal of Oncology 2022; 18: e-20220291
DOI: 10.5935/2526-8732.20220291
Original Article
Clinical Oncology

Acute kidney injury in children with cancer admitted in an intensive care unit

Lesão renal aguda em crianças com câncer internadas em unidade de terapia intensiva
1   Santa Casa de Belo Horizonte, Terapia Intensiva Pediátrica - Belo Horizonte - Minas Gerais - Brazil
,
Gabriela Caus Fernandes Luiz
2   Hospital Infantil Pequeno Príncipe, Oncologia Pediátrica - Curitiba - Paraná - Brazil
,
Scheilla Torres De-Oliveira
3   Santa Casa de Belo Horizonte, Oncologia Pediátrica - Belo Horizonte - Minas Gerais - Brazil
,
Larissa Nicolini De-Santa
4   Universidade Positivo, Faculdade de Medicina - Curitiba - Paraná - Brazil
,
Giovanna Soldatelli Borsato
5   Pontifícia Universidade Católica do Paraná, Faculdade de Medicina - Curitiba - Paraná - Brazil
,
Paulo Ramos David João
6   Hospital Infantil Pequeno Príncipe, Terapia Intensiva Pediátrica - Curitiba - Paraná - Brazil
› Author Affiliations
Financial support: None to declare.

ABSTRACT

Objective: Evaluating the association between acute kidney injury and death in critically ill children with oncological diseases admitted in an intensive care unit (ICU).

Material and Methods: Unicentric cohort study, evolving children with cancer admitted in the ICU of a pediatrics referral hospital. The patients were divided according to the presence or absence of acute kidney injury. Patients with a history of urogenital disease, nephrectomy or chronic kidney disease were excluded. The acute kidney injury was defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification. The main outcome was death.

Results: The sample was composed of 84 patients, in which 46.4% were diagnosed with hematologic neoplasm, 29.8% evolved with febrile neutropenia, 11.9% had a history of bone marrow transplant, and 27.3% deceased. Acute kidney injury occurred in 51.2% of the sample, 53.6% used furosemide, 38% showed fluid overload, and 8.3% had renal replacement therapy. The main variables related to kidney dysfunction were admission due to hemodynamic shock, pediatric risk of mortality score 2 ≥5%, bone marrow transplant, volume overload and multiple organ dysfunction syndrome. More advanced stages of acute kidney injury were associated with renal replacement therapy (p<0.001), longer stay in the ICU (p=0.006), and death (p=0.003).

Conclusion: Children with cancer showed many risk factors of acute kidney injury, and this complication is associated with higher death rate.

RESUMO

Objetivo: Avaliar a associação entre lesão renal aguda e óbito em crianças com doenças oncológicas criticamente enfermas internadas em uma unidade de terapia intensiva (UTI).

Material e Métodos: Estudo de coorte unicêntrico, envolvendo crianças com câncer internadas na UTI de um hospital de referência em pediatria. Os pacientes foram divididos de acordo com a presença ou ausência de lesão renal aguda. Pacientes com história de doença urogenital, nefrectomia ou doença renal crônica foram excluídos. A lesão renal aguda foi definida pela classificação do Kidney Disease Improving Global Outcomes (KDIGO). O desfecho principal foi a morte.

Resultados: A amostra foi composta por 84 pacientes, em que 46,4% foram diagnosticados com neoplasia hematológica, 29,8% evoluíram com neutropenia febril, 11,9% tinham histórico de transplante de medula óssea e 27,3% foram a óbito. A lesão renal aguda ocorreu em 51,2% da amostra, 53,6% usaram furosemida, 38% apresentaram sobrecarga hídrica e 8,3% fizeram terapia renal substitutiva. As principais variáveis relacionadas à disfunção renal foram admissão por choque hemodinâmico, escore pediatric risk of mortality 2 ≥5%, transplante de medula óssea, sobrecarga de volume e síndrome de disfunção de múltiplos órgãos. Estágios mais avançados de lesão renal aguda foram associados à terapia renal substitutiva (p<0,001), maior permanência na UTI (p=0,006) e óbito (p=0,003).

Conclusão: Crianças com câncer apresentaram muitos fatores de risco de lesão renal aguda, e esta complicação está associada a uma maior taxa de mortalidade.



Publication History

Received: 10 August 2021

Accepted: 19 February 2022

Article published online:
22 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Jáder Pereira Almeida, Gabriela Caus Fernandes Luiz, Scheilla Torres De-Oliveira, Larissa Nicolini De-Santa, Giovanna Soldatelli Borsato, Paulo Ramos David João. Acute kidney injury in children with cancer admitted in an intensive care unit. Brazilian Journal of Oncology 2022; 18: e-20220291.
DOI: 10.5935/2526-8732.20220291
 
  • REFERENCES

  • 1 Fragasso T, Ricci Z, Goldstein SL. Pediatric acute kidney injury. Contrib Nephrol 2018; 193: 113-116
  • 2 Patzer L. Nephrotoxicity as a cause of acute kidney injury in children. Pediatr Nephrol 2008; Dec; 23 (12) 2159-2173
  • 3 Berg ST, Loeffen EAH, Van de Wetering MDV, Martens DHJ, Van Ede CM, Kremer LCM. et al. Development of pediatric oncology supportive care indicators: evaluation of febrile neutropenia care in the north of the Netherlands. Pediatr Blood Cancer 2019; Feb; 66 (02) e27504
  • 4 Park PG, Hong CR, Kang E, Park M, Lee H, Kang HJ. et al. Acute kidney injury in pediatric cancer patients. J Pediatr 2019; May; 208: 243-50.e3
  • 5 Rosner MH, Perazella MA. Acute kidney injury in patients with cancer. N Engl J Med 2017; May; 377 (05) 1770-1781
  • 6 Asperen RMWV, Van Gestel JPJ, Van Grotel M, Tschiedel E, Dohna-Schwake C, Valla FV. et al. PICU mortality of children with cancer admitted to pediatric intensive care unit a systematic review and meta-analysis. Crit Rev Oncol Hematol 2019; Oct; 142: 153-163
  • 7 Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL. et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2 (01) 1-138
  • 8 Goldstein SL, Kirkendall E, Ngouyen H, Schaffzin JK, Bucuvalas J, Bracke T. et al. Eletronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics 2013; Set; 132 (03) 757-767
  • 9 Alobaidi R, Morgan C, Basu RK, Stenson E, Feathersone R, Majumdar SR. et al. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr 2018; 172 (03) 257-268
  • 10 Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; Jan; 6 (01) 2-8
  • 11 Kaddourah A, Basu RK, Bagshaw SM, Goldstein AL. AWARE Investigators. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 2017; Jan; 376 (01) 11-20
  • 12 De Zan F, Amigoni A, Pozzato R, Pettenazzo A, Murer L, Vidal E. Acute kidney injury in critically ill children: a retrospective analysis of risk factors. Blood Purif 2020; 49 (1-2): 1-7
  • 13 Abraham RB, Toren A, Ono N, Weinbroum AA, Vardi A, Barzilay Z. et al. Predictors of outcome in the pediatric intensive care units of children with malignancies. J Pediatr Hematol Oncol 2002; Jan; 24 (01) 23-26
  • 14 Dursun O, Hazar V, Karasu GT, Uygun V, Tosun O, Yesilipek A. Prognostic factors in pediatric cancer patients admitted to the pediatric intensive care unit. J Pediatr Hematol Oncol 2009; Jul; 31 (07) 481-484
  • 15 Akhtar N, Fadoo Z, Panju S, Haque A. Outcome and prognostic factors seen in pediatric oncology patients admitted in PICU of a developing country. Indian J Pediatr 2011; Aug; 78 (08) 969-972
  • 16 Freire KMS, Bresolin NL, Farah ACF, Carvalho FLC, Góes JEC. Acute kidney injury in children: incidence and prognostic factors in critical ill patients. Rev Bras Ter Intensiva 2010; Jun; 22 (02) 166-174
  • 17 Haase R, Lieser U, Kramm C, Stiefel M, Vilser C, Bernig T. et al. Management of oncology patients admitted to the paediatric intensive care unit of a general children' s hospital - a single center analysis. Klin Padiatr 2011; May; 223 (03) 142-146
  • 18 Fiser RT, West NK, Bush AJ, Sillos EM, Schmidt JE, Tamburro RF. Outcome of severe sepsis in pediatric oncology patients. Pediatr Crit Care Med 2005; Sep; 6 (05) 531-536
  • 19 Ali AM, Sayed HA, Elzembely MM. The outcome of critically ill pediatric cancer patients admitted to the pediatric intensive care unit in a tertiary university oncology center in a developing country. J Pediatr Hematol Oncol 2016; Jul; 38 (05) 355-359
  • 20 Basu SK, Fernandez ID, Fisher SG, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Clin Oncol 2005; Nov; 23 (31) 7958-7966
  • 21 Lopes JA, Jorge S, Neves M. Acute kidney injury in HCT: an update. Bone Marrow Transplant 2016; Jun; 51 (06) 755-762
  • 22 Fernández-García M, Gonzalez-Vicent M, MastroMartinez I, Serrano A, Diaz MA. Intensive care unit admissions among children after hematopoietic stem cell transplantation: incidence, outcome, and prognostic factors. J Pediatr Hematol Oncol 2015; Out; 37 (07) 529-535
  • 23 Koh KN, Sunkara A, Kang G, Sooter A, Mulrooney DA, Triplett B. et al. Acute kidney injury in pediatric patients receiving allogeneic hematopoietic cell transplantation: incidence, risk factors, and outcomes. Biol Blood Marrow Transplant 2018; Apr; 24 (04) 758-764
  • 24 Kizilbash SJ, Kashtan CE, Chavers BM, Cao Q, Smith AR. Acute kidney injury and the risk of mortality in children undergoing hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2016; Jul; 22 (07) 1264-1270
  • 25 Gist KM, Selewski DT, Brinton J, Menon S, Goldstein S, Basu RK. Assessment of the independent and synergistic effects of fluid overload and acute kidney injury on outcomes of critically ill children. Pediatr Crit Care Med 2020; Feb; 21 (02) 170-177
  • 26 Samaddar S, Sankar J, Kabra SK, Lodha R. Association of fluid overload with mortality in critically-ill mechanically ventilated children. Indian Pediatr 2018; Nov; 55 (11) 957-961
  • 27 Lopes CLS, Piva JP. Fluid overload in children undergoing mechanical ventilation. Rev Bras Ter Intensiva 2017; Jul/Sep; 29 (03) 335-346
  • 28 Raymakers-Janssen PA, Lilien MR, Tibboel D, Kneyber MC, Dijkstra S, Van Woensel JB. et al. Epidemiology and outcome of critically Ill pediatric cancer and hematopoietic stem cell transplant patients requiring continuous renal replacement therapy: a retrospective nationwide cohort study. Crit Care Med 2019; Nov; 47 (11) e893-e901
  • 29 Cortina G, McRae R, Hoq M, Donath S, Chiletti R, Arvandi M. et al. Mortality of critically ill children requiring continuous renal replacement therapy: effect of fluid overload, underlying disease, and timing of initiation. Pediatr Crit Care Med 2019; Apr; 20 (04) 314-322
  • 30 Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, David P. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020; Feb; 21 (02) e52-e106
  • 31 Almeida JP, João PRD, Sylvestre LC. Impact of the use of nephrotoxic drugs in critically ill pediatric patients. Rev Bras Ter Intensiva 2020; 32 (04) 557-563