Characteristics of Acute Kidney Injury (AKI) in Children With Cancer and in the Bone Marrow Transplant Unit: An Analysis of an AKI Registry From a Tertiary Cancer Center.

Objective Detection and tracing of acute kidney injury (AKI) in children with cancer in Jordan and the developing world are very limited. The objective of this paper is to report the incidence, the outcome, risk factors, as well as some clinical parameters associated with AKI in children with cancer. Methodology This study is based on an analysis of a registry that was established for children with cancer who develop AKI. The aim of the registry was to detect, trace, define risk factors, and maintain follow-up for children who develop AKI at King Hussein Cancer Center (KHCC). A flag system was established for all children who develop AKI. The pediatric department at KHCC is composed of four locations. These include the pediatric ward, bone marrow transplant (BMT) unit, pediatric intensive care unit (PICU), and the emergency room (E/R). Analysis was done in all locations. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results During the study period, there were 16,273 total hospital admissions, and the cancer registry included 4,482 unique patients. A total of 473 AKI attacks occurred, representing 2.9% of all admissions. These attacks occurred in 374 patients, indicating that 8.3% of cancer patients experienced at least one AKI episode. The mean follow-up duration was 2.27 ± 1.28 years. In the pediatric ward, 134 attacks of AKI were recorded (1.1% of admissions; 5.7% of patients). In the BMT unit, 117 attacks of AKI were recorded (4.3% of admissions; 6.9% of patients). In the PICU, 74 attacks of AKI were recorded (4.4% of admissions; 10.8% of patients). The most common place of developing AKI for patients at KHCC was in the home setting (community acquired) as 148 (31.3%) of patients who had AKI presented to the E/R with AKI, 134 (28.3%) had AKI while in the ward, 117 (24.7%) patients while in the BMT unit, and 74 (15.6%) patients while in the ICU. Fifty-four (14.4%) patients had two attacks, 15 (4.0%) had three attacks, and five (1.3%) had more than three attacks of AKI. The maximum stage of AKI reached was stage 1 in 204 (43.1%) patients, stage 2 in 167 (35.3%) patients, and stage 3 in 102 (21.6%) patients. In the PICU stage, three was the most common maximum stage reached. The main cause of AKI at KHCC was nephrotoxic medications in 204 (43.1%) of patients. High-dose methotrexate (MTx) was the most common single drug to cause AKI in 34 (16.7%) patients. The most common cause for home-acquired AKI was pre-renal in 47 (32%) patients. The most common malignancy in children who developed AKI was hematological in 230 (48.6%) patients. Residual renal damage was detected following 66 (14%) patients. Another 38 (8%) patients passed away, suggesting a higher mortality in children who developed AKI than in children without AKI. Renal replacement therapy (RRT) was done for 15 patients (3.2%), whereas 458 patients (96.8%) did not need RRT. Conclusion AKI in children with cancer shares many features with AKI in the general pediatric population, with multiple similar clinical manifestations. However, oncology patients have unique risk factors - most notably nephrotoxic chemotherapy, tumor lysis syndrome, sepsis, and obstructive uropathy - which distinguish their AKI profile. Variations between units within the same center can also influence AKI patterns. An in-center registry is therefore essential for early detection and ongoing monitoring of AKI cases.