Evaluation of kidney function and body composition in adult survivors of unilateral, non-metastatic, non-syndromic Wilms tumor: A report from the St. Jude Lifetime Cohort Study.

person Daniel M. Green St. Jude Children's Research Hospital, Memphis, TN info_outline Daniel M. Green, Kendrick Li, Sue C. Kaste, Kirsten K. Ness, Matthew J. Krasin, Lu Xie, Carmen L Wilson, Deo Kumar Srivastava, Andrew M. Davidoff, Rima S Zahr, Siddhant Taneja, Kyla C. Shelton, Jennifer Q. Lanctot, Stephanie B Dixon, Matthew J. Ehrhardt, Daniel A. Mulrooney, Chelsea Goodliffe Goodenough, Gregory T. Armstrong, Leslie L. Robison, Melissa M. Hudson

Authors person Daniel M. Green St. Jude Children's Research Hospital, Memphis, TN info_outline Daniel M. Green, Kendrick Li, Sue C. Kaste, Kirsten K. Ness, Matthew J. Krasin, Lu Xie, Carmen L Wilson, Deo Kumar Srivastava, Andrew M. Davidoff, Rima S Zahr, Siddhant Taneja, Kyla C. Shelton, Jennifer Q. Lanctot, Stephanie B Dixon, Matthew J. Ehrhardt, Daniel A. Mulrooney, Chelsea Goodliffe Goodenough, Gregory T. Armstrong, Leslie L. Robison, Melissa M. Hudson Organizations St. Jude Children's Research Hospital, Memphis, TN, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN Abstract Disclosures Research Funding No funding sources reported Background: The relationships among treatment exposures, body composition and estimated glomerular filtration rate (eGFR) in adult survivors of childhood have not been well studied. Methods: We evaluated body composition with dual energy x-ray absorptiometry (DXA) and eGFR with the Kidney Disease International Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) in 149 adults previously treated for non-syndromic, non-metastatic, unilateral Wilms tumor at St. Jude Children’s Research Hospital between 1964 and 2004 with chemotherapy and with [(whole abdomen (WA) radiation therapy (RT) – 41 patients; median dose 12.5 Gray (Gy), Interquartile Range (IQR) 12.5 – 20.0 Gy); (hemiabdomen (HA) RT – 30 patients; median dose 12.0 Gy, IQR 10.8 – 20.1 Gy)] or without (78 patients) RT. z-scores for DXA variables were calculated using data from the National Health and Nutrition Survey (1). Results: The study population [56 males (37.6%), 109 whites (73.2%)] was a median of 3.1 years of age at diagnosis (IQR: 1.7-4.3) and 23.4 years at evaluation (IQR: 23.4-35.5). Relative total and relative trunk lean mass, and eGFR were significantly decreased among those who received WART compared to unirradiated patients. Linear regression demonstrated that WART was significantly associated with a lower eGFR (p = 0.012) and higher value of creatinine (p = 0.013). Conclusions: Relative total and relative trunk lean mass, and eGFR are decreased in survivors of unilateral, non-metastatic, non-syndromic WT following WART. Although eGFR was in the normal range, eGFR may be inaccurate due to loss of lean mass. Assessments using non-secreted molecules may more accurately measure the magnitude of kidney function loss among WART treated WT survivors. 1. PLoS ONE 2009;4(9):e7038. z-score [mean (Standard Deviation)] RTotLM RALM RTruLM RTruFM No RT -0.27(1.10) -0.44 (1.12) 0.07 (1.15) 0.16 (1.08) HART -0.42 (1.37) -0.10 (1.29) -0.57 (1.58) -0.12 (1.41) WART -1.02 (1.57)* -0.30 (1.40) -1.73 (1.54)** -0.60 (1.31) eGFR (ml/min/1.73m 2 ) [mean (standard deviation)] No RT 103.83 (16.75) HART 96.38 (17.72) WART 94.39 (17.54)*** HART - hemiabdomen radiation therapy; WART - whole abdomen radiation therapy; RTotLM - relative total lean mass; RALM - relative appendicular lean mass; RTruLM - relative trunk lean mass; RTruFM - Relative trunk fat mass; *p = 0.018; **p < 0.001; ***p = 0.005 (WART vs None).