Article
De novo malignancy after paediatric renal replacement therapy
H M Coutinho, J W Groothoff, M Offringa, M P Gruppen, H S A Heymans
Department of
Paediatric Nephrology, Department of Paediatrics, Emma Children's
Hospital AMC, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam,
Netherlands
Correspondence to: Dr Groothoff j.w.groothoff{at}amc.uva.nl
Accepted 13 August
2001
AIMS
To determine frequency, type,
determinants, and outcome of malignancies in children with end stage
renal failure.
METHODSAll Dutch patients, aged
less than 15 years, who started chronic renal replacement therapy
between 1972 and 1992 and who were at least 18 years old on 1 January
1997, were retrospectively studied.
RESULTSMean follow up from first
renal replacement therapy was 15.5 years. Twenty two malignancies were
found in 21 of 249 patients. Skin cancer accounted for 59% and
non-Hodgkin lymphoma for 23% of malignancies. At 25 years after first
renal replacement therapy, the probability of developing a malignancy
was 17% (95% CI: 9 to 24%). Compared to the general population the
incidence rate for overall cancer was tenfold higher. For non-melanoma
skin cancer and non-Hodgkin lymphoma, standardised risks were 222 and
46 respectively. The use of more than 20 mg/kg cyclophosphamide showed
an association with increased risk of malignancy. Six patients died as
a result of their malignancy, accounting for 9.5% of overall
mortality. Whereas four out of five patients with non-Hodgkin lymphoma
died, the most frequent malignancy, skin cancer, did not contribute to mortality.
CONCLUSIONThe long term risk of
certain malignancies is significantly increased in children who have
undergone renal replacement therapy. As an important contributor to
overall mortality, awareness of this risk of malignancy in these
patients is necessary, especially after treatment with cyclophosphamide.
Keywords: renal replacement therapy; malignancy; follow up
© 2001 by Archives of Disease in Childhood
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