Childhood Cancer Survivors at an Increased Risk of Developing CKD, Study Finds

In a recent study published in JAMA Network Open, childhood cancer survivors (CCS) were found to be at an increased risk for developing chronic kidney disease (CKD) compared with a hospitalized cohort. In addition to CKD, the survivors were also found to have an increased risk of hypertension. The authors suggest that early detection and treatment of these conditions among CCS may decrease late complications and mortality.¹

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CKD is a significant public health concern that has been on the rise both in the US and worldwide. Approximately 35.5 million US adults are estimated to have CKD. As many as 9 in 10 adults with CKD and 1 in 3 adults with severe CKD do not know they have it. Additionally, the disease worsens over time and has multifactorial causes, including high blood pressure and diabetes. Currently, there is no cure for CKD; however, there are steps that can be taken to preserve kidney function for a sustained period.^1,2

The current study is a population-based matched cohort study of children who were treated for cancer between April 1993 and March 2020 in Ontario, Canada, with a follow-up until March 2021. The CCS cohort (also referred to as the exposed cohort) included children younger than 18 years who survived cancer. Comparator cohorts included a hospitalization cohort and a general pediatric population (GP) cohort. Exclusion criteria were previous history of cancer, organ transplant, prior CKD, dialysis, or hypertension. Matching with each of the 2 comparator cohorts was performed separately and in a 1:4 ratio by age, sex, rural vs urban status, income quintile, index year, and presence of previous hospitalization. The investigators analyzed data from March 2021 to August 2024.¹

The study’s primary end point was the composite of CKD or hypertension, which was defined by both administrative health care diagnosis and procedure codes. Further, the investigators utilized Fine and Gray subdistribution hazard modeling, and accounted for competing risks (eg, death, new cancer diagnosis or relapse) and made adjustments for cardiac disease, liver disease, and diabetes when necessary. These were used to determine the association of cancer treatment with outcomes.¹

A total of 10,182 CCS (median age at diagnosis: 7 years [IQR: 3-13 years]; median [IQR] follow-up time: 8 years [IQR: 2-15 years]) patients were enrolled and matched to 40,728 patients in the hospitalization cohort (median age at diagnosis: 7 years [IQR: 2-12 years], weighted percentage: 54.3%; median follow-up time: 11 year [IQR: 6-18 years]). Additionally, 8849 CCS (median age at diagnosis: 5 years [IQR: 2-11 years]; median follow-up time: 7 years [ IQR: 2-14 years]) were matched to 35,307 GP cohort individuals (median age at diagnosis: 6 years [IQR: 2-11 years]; median follow-up time: 10 years [IQR: 5-16 years]).¹

The most frequent cancer types were leukemia (2948 patients, 29.0%), central nervous system neoplasms (2123 patients, 20.9%), and lymphoma (1583 patients, 15.5%). During observation, the cumulative incidence of CKD or hypertension was approximately 20.85% (95% CI, 18.75%-23.02%) in the CCS cohort compared with 16.47% (95% CI, 15.21%-17.77%) in the hospitalization cohort, and 19.24% (95% CI, 15.99%-22.73%) in the CCS cohort compared with 8.05% (95% CI, 6.76%-9.49%) in the GP cohort. Of note, CCS were at increased risk of CKD or hypertension compared with the hospitalization cohort (adjusted HR, 2.00 [95% CI, 1.86-2.14]; P < .001) and the GP cohort (adjusted HR, 4.71 [95% CI, 4.27-5.19]; P < .001).¹

Limitations of the study, according to the investigators, included the following: the inability to differentiate CKD manifestations (eg, low GFR or albuminuria) and stages, potential biased information because current guidelines provide poor guidance on kidney health and blood pressure follow-up, and inability to factor in acute kidney injury (AKI) during cancer therapy as a variable, among others. The investigators suggested that future research should emphasize how best to evaluate the association of AKI with long-term kidney health in CCS compared with other children at risk.¹

REFERENCES

1. Lebel A, Chanchlani R, Cockovski V, et al. Chronic Kidney Disease or Hypertension After Childhood Cancer. JAMA Netw Open. 2025;8(5):e258199. doi:10.1001/jamanetworkopen.2025.8199

2. Shalumova L. The Role of Specialty Pharmacists in Managing Chronic Kidney Disease. Pharmacy Times. May 16, 2025. Accessed May 28, 2025. https://www.pharmacytimes.com/view/the-role-of-specialty-pharmacists-in-managing-chronic-kidney-disease