Lookup NU author(s): Professor Roderick Skinner,
Professor Andrew Pearson
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Background. This prospective longitudinal single institution cohort study evaluated the natural history of and risk factors for chronic nephrotoxicity 10 years after ifosfamide treatment in childhood. Procedure. Twenty-five patients (16 males) treated with ifosfamide were investigated at end of treatment (End), 1 and 10 years later. Glomerular filtration rate (GER), serum phosphate (PO4) and bicarbonate (HCO3) and renal tubular threshold for phosphate (Tm-p/GFR) were measured, and total nephrotoxicity score (N-s) graded. Results. More patients had a low GFR at 1 (72%) and 10 (50%) years than at End (26%) (P=0.006 for End vs. 1 year). Electrolyte supplementation requirements for tubular toxicity resolved by 10 years (0% vs. 32% at End and 24% at 1 year; both P< 0.05). At 10 years, 17% of patients had moderate overall nephrotoxicity and 13% clinically significant reduction of GER (<60 ml/min/1.73 m(2)). Neither dose nor age at treatment predicted any measure of toxicity at 10 years or reduced GER at any timepoint. Higher cumulative ifosfamide close correlated with greater tubular and overall nephrotoxicity at End and/or 1 year (P < 0.05 for each of PO4, HCO3, Tm-p/GER, N-s), but age at treatment did not differ between patients with normal or abnormal results. Conclusions. Although clinically significant tubular toxicity had resolved by 10 years, GER was <60 ml/min/1.73 m(2) in 13% of patients, raising concerns about very long-term glomerular function. Higher cumulative dose was associated with greater tubular and overall toxicity at End and 1 year, but not at 10 years. Age at treatment did not predict nephrotoxicity at any timepoint. Pediatr Blood Cancer 2010;54: 983-989. (C) 2010 Wiley-Liss, Inc.
Author(s): Skinner R, Parry A, Price L, Cole M, Craft AW, Pearson ADJ
Publication type: Article
Publication status: Published
Journal: Pediatric Blood & Cancer
Print publication date: 01/07/2010
Date deposited: 04/08/2010
ISSN (print): 1545-5009
ISSN (electronic): 1545-5017
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