Long-Term Kidney Outcomes of Pediatric Acute Lymphoblastic Leukemia Survivors
Bibliographic record
Abstract
Background: Hypertension (HTN) and chronic kidney disease (CKD) have been described in pediatric cancer survivors but renal outcomes following childhood acute lymphoblastic leukemia (cALL), the most frequent pediatric cancer, remain poorly defined. We aimed to determine the prevalence of abnormal estimated glomerular filtration rate (eGFR) and HTN among cALL survivors in the short- and long-term and assess potential associations with clinical characteristics prior to end of treatment. Methods: This is a retrospective cohort study of 237 cALL survivors with no prior kidney disease. Clinical, imaging, and laboratory data were documented from cALL diagnosis to end of treatment (1987-2010) and at study follow-up (2013-2015). Logistic regression models were used to examine relationships between clinical characteristics and kidney outcomes. Results: 49.8% of the cohort were males and median age at diagnosis was 4.8 (IQR = 3.0-9.8) years. By end of treatment, HTN and acute kidney injury (AKI) were diagnosed in 15.3% and 34.2% of patients respectively. Stage 1 AKI represented 77.8% of all AKI episodes. Initial ultrasound findings suggestive of leukemic kidney infiltration (LKI) and tumor lysis syndrome (TLS) were associated with higher AKI risk. HTN risk was higher among children younger than 5 years old (OR 2.3; 95% CI 1.1-4.8), those with LKI (3.5; 1.5-7.9), and who had AKI (2.5; 1.2-5.2). Median length of follow-up was 15.0 (11.6-19.7) years, with median age of 21.4 (16.8-25.9) years old. High blood pressure values suggesting HTN were recorded in 11.5% of patients. Mean eGFR was 100.3±15.7 ml/min/1.73m2, with no difference between patients who had previous severe AKI episodes versus not. 27.1% of the cohort met criteria for stage 2 CKD (eGFR < 90 ml/min/1.73 m2). CKD at long-term follow-up was not associated with number of AKI episodes, AKI severity, nor HTN prior to end of treatment. Prior severe AKI episodes were associated with high blood pressure at follow-up (5.1; 1.7-15.2). Conclusions: Attention may be warranted for patients with ultrasound findings suggestive of LKI and TLS prior to end of treatment. cALL survivors who had severe AKI would benefit from long-term blood pressure monitoring. All cALL survivors should have their kidney function monitored as over 1 in 4 had stage 2 CKD by early adulthood, regardless of previous AKI or HTN diagnoses.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".