Table 1. Characteristics of Study Population at the EV and LV by SCr-AKI Statusa.
| Characteristic | EV | LV | |||
|---|---|---|---|---|---|
| SCr-AKI (n = 48) | No SCr-AKI (n = 111) | SCr-AKI (n = 23) | No SCr-AKI (n = 120) | ||
| Baseline (before first cisplatin infusion) | |||||
| Male | 23 (48) | 57 (51) | 8 (35) | 61 (51) | |
| White race/ethnicity | 39 (81) | 78 (70) | 18 (78) | 89 (74) | |
| Cancer diagnosis | |||||
| CNS tumorb | 20 (42)c | 38 (34) | 11 (48)d | 44 (37) | |
| Neuroblastoma | 18 (38) | 25 (23) | 8 (35) | 23 (19) | |
| Osteosarcoma | 2 (4) | 31 (28) | 0 (0) | 33 (28) | |
| Germ cell tumor | 3 (6) | 11 (10) | 0 (0) | 14 (12) | |
| Hepatoblastoma | 4 (8) | 5 (5) | 3 (13) | 6 (5) | |
| Othere | 1 (2) | 1 (1) | 1 (4) | 0 (0) | |
| Cancer involves 1 or both kidneys | 5 (10) | 6 (5) | 3 (13) | 4 (3) | |
| Kidney medical historyf | 8 (17)c | 5 (5) | 1 (4) | 10 (8) | |
| Any nephrotoxic drug before first cisplatin infusiong | 12 (25) | 15 (14) | NA | NA | |
| Vancomycin in 2 wk before cisplatin infusion | 5 (10) | 3 (3) | NA | NA | |
| Immediately before or on the day of EV or LV infusion | |||||
| Age at EV or LV, median (IQR), y | 2.7 (2.0-6.8)d | 7.5 (3.1-13.4) | 2.6 (2.2-4.7)c | 7.7 (2.6-13.7) | |
| Age <3 y | 26 (54)c | 26 (23) | 13 (57)c | 32 (27) | |
| Cisplatin naive at the EV | 31 (65) | 60 (54) | NA | NA | |
| Previsit eGFR, median (IQR), mL/min/1.73 m2h | 166 (140-206)d | 132 (115-155) | 169 (156-202)d | 133 (114-163) | |
| Preinfusion serum level, mean (SD)i | |||||
| Phosphorus, mg/dL | 4.8 (1.6) | 4.6 (0.9) | 4.3 (0.8)c | 4.8 (0.9)j | |
| Magnesium, mEq/L | 1.6 (0.3) | 1.6 (0.2) | 1.5 (0.2) | 1.6 (0.2)j | |
| Last cisplatin cycle of treatment at LV | NA | NA | 19 (83) | 100 (83) | |
| Cumulative cisplatin dose before the EV or LV, median (IQR), mg/m2 | 82 (77-127)k | 109 (77-120)k | 168 (154-204)c | 224 (167-353) | |
| EV or LV cisplatin infusion dose, median (IQR), mg/m2 | 65 (50-77) | 59 (49-74) | 75 (49-80)c | 58 (37-71) | |
| Before EV or LV | |||||
| Infection | 6 (13) | 14 (13) | 12 (52) | 38 (32) | |
| PICU admission | 1 (2) | 1 (1) | 4 (17) | 9 (8) | |
| SCr-AKI episodel | 11 (23)c | 8 (7) | 15 (65) | 52 (43) | |
| Between EV and LV visits, median (IQR), d | NA | NA | 42 (29-64)c | 69 (42-118) | |
| Concurrent nephrotoxins at EV or LVm | 3 (6) | 20 (18) | 2 (9) | 20 (17) | |
| Cancer treatment | |||||
| EV or LV total cisplatin cycle dose, median (IQR), mg/m2 | 100 (77-175) | 109 (77-122) | 83 (76-155) | 100 (75-120) | |
| Any flank, whole abdomen, pelvic, or total body radiotherapy planned | 10 (21) | 12 (11) | 3 (13) | 12 (10) | |
| After cisplatin | |||||
| EV or LV length of stay, median (IQR), d | 5 (4-24)d | 4 (3-5) | 4 (3-11)c | 4 (2-5) | |
| Nephrotoxins in 10 d after EV or LVn | 6 (13) | 7 (6) | 1 (4) | 10 (8) | |
Abbreviations: AKI, acute kidney injury; CNS, central nervous system; eGFR, estimated glomerular filtration rate; EV, early visit; IQR, interquartile range; LV, late visit; NA, not applicable; PICU, pediatric intensive care unit; SCr-AKI, serum creatinine–based AKI.
SI conversion factors: To convert magnesium to millimoles per liter, multiply by 0.5; phosphorus to millimoles per liter, multiply by 0.323.
Data are presented as number (percentage) of patients unless otherwise indicated. Percentages are based on the total for each column.
Astrocytoma (n = 3), choroid plexus tumor (n = 2), ependymoma (n = 1), medulloblastoma (n = 39), primitive neuroectodermal tumor (n = 7), and atypical teratoid or rhabdoid tumor (n = 6).
Significant difference between AKI and non-AKI groups for that time (P < .05).
Significant difference between AKI and non-AKI groups for that time (P < .001).
Lymphoma and nasopharyngeal carcinoma.
Hypertension, treatment with antihypertensives, family history of kidney disease, chronic kidney disease, dialysis, congenital kidney anomaly, kidney stones, vesicoureteral reflux, urinary tract infection and/or serum electrolyte abnormality requiring treatment, or AKI.
Receipt of acyclovir, amphotericin, aminoglycosides (gentamycin, tobramycin, or amikacin), vancomycin, angiotensin-converting enzyme inhibitor, ganciclovir, valganciclovir, ifosfamide, or methotrexate in the 2 weeks before cisplatin infusion.
Calculated using the updated Chronic Kidney Disease in Children equation.
Preinfusion electrolyte levels were determined by using the study-measured electrolyte (measured before or on day of cisplatin infusion); if unavailable, the most recent available routine electrolyte value was used. For the LV non-AKI group, n = 118 (preinfusion serum phosphorous and magnesium values not available for 2).
N = 118 (preinfusion electrolyte value not available for 2).
Data for 17 patients with SCr-AKI and 51 without (none were cisplatin naive at the EV).
All routine and study-measured SCr values measured before cisplatin infusion at the EV or LV were used. Peak SCr level was the highest SCr level occurring before the EV and LV infusion but occurring after the baseline SCr measurement. For SCr-AKI before the EV, the baseline SCr level was the lowest routine value in the 3 months before cisplatin initiation. For AKI between the EV and LV, the baseline SCr level was the lowest routine or study-measured value in 3 months before the first cisplatin infusion.
Acyclovir, amphotericin, aminoglycosides (gentamycin, tobramycin, or amikacin), ifosfamide, or chemotherapy protocol indicates that a nephrotoxin (aldesleukin, busulfan, carboplatin, dinutuximab, gemcitabine, ifosfamide, lomustine, melphalan, methotrexate, radiotherapy, rituximab, stem cell transplant, or temsirolimus) was given within 24 hours of cisplatin infusion.
Acyclovir, amphotericin, aminoglycosides (gentamycin, tobramycin, or amikacin), and/or ifosfamide.