Superiority Of Cystatin C Over Creatinine For Early Diagnosis Of Acute Kidney Injury in Pediatric Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma Ⅱ

Results 

Incidence rate and severity of AKI 

We examined 16 individuals undergoing a total of 75 courses of chemotherapy. Of these, 12 were male and the median age was 9.4 years with an interquartile range (IQR) of 7.2 to 13.1 years. The median height was 132.5 cm (IQR, 117.8 to 153.4 cm), and the median body weight was 28.7 kg (IQR, 19.1 to 42.4 kg). The body mass index was 16.3 (IQR, 15.7 to 18.4) kg/m2. The median Z-scores for height and weight based on Japanese growth standards (Isojima et al. 2016) were −0.3 (IQR, −1.0 to 0.5) and −0.6 (IQR, −1.1 to 0.3), respectively (Table 1). 

As shown in Table 3, all 16 patients developed AKI during chemotherapy (100% incidence) and eventually recovered. During the 75 courses, AKI was diagnosed in 58 courses by CysC-based eGFR (77%: "Risk" 72%, "Injury" 4.0%, "Failure" 1.3%, "Loss" 0%) and in 49 courses by Cr-based eGFR (65%: "Risk" 61%, "Injury" 2.7%, "Failure" 1.3%, "Loss" 0%). AKI was diagnosed in 42 courses by both CysC-based eGFR and Cr-based eGFR (56%) though none developed tumor lysis syndrome during chemotherapy

Supportive Service Of Wecistanche-The largest cistanche exporter in the China:

Email:wallence.suen@wecistanche.com 

Whatsapp/Tel:+86 15292862950

Shop For More Specifications Details:

https://www.xjcistanche.com/cistanche-shop

CLICK HERE TO GET NATURAL ORGANIC CISTANCHE EXTRACT WITH 25% ECHINACOSIDE AND 9% ACTEOSIDE FOR KIDNEY FUNCTION

Since glucocorticoids may affect serum CysC levels (Bardi et al. 2010; Nakamura et al. 2018; Cimerman et al. 2000), the incidence of AKI based on CysC-based eGFR was compared by glucocorticoid therapy status. No significant differences were found in the incidence of AKI: 77.4% during chemotherapy with glucocorticoids and 77.3% during chemotherapy without glucocorticoids. The incidence of AKI by type of chemotherapy course is shown in Table 4. AKI occurred frequently in consolidation courses that included methotrexate. AKI was detected in 24 of 25 consolidation courses (96%) based on CysC-based eGFR and 22 of 25 consolidation courses (88%) based on Cr-based eGFR (Table 4).

A discrepancy was found in 23 courses regarding the incidence of AKI diagnosed by CysC-based eGFR and Cr-based eGFR: 7 courses were diagnosed as having AKI only by Cr-based eGFR, while 16 courses were diagnosed as having AKI only by CysC-based eGFR (Table 3). However, no significant difference was observed in the incidence of AKI regardless of whether CysC-based eGFR or Cr-based eGFR was used for diagnosis (p = 0.104).

Days until the onset of AKI 

Moreover, for the 42 courses in which AKI was diagnosed by both CysC- and Cr-based eGFR, we compared the number of days from the start of each treatment course to AKI diagnosis. The median time to AKI diagnosis was significantly shorter for CysC-based eGFR (8 days [IQR, 4 to 21 days]) than for Cr-based eGFR (17 days [IQR, 10 to 31 days], p < 0.001) (Fig. 1). Among the 42 courses in which AKI developed, there were serial changes in the reduction rate of the CysC- and Cr-based eGFR over the 2 weeks since the start of chemotherapy (Fig. 2). The CysC-based eGFR demonstrated an earlier decline than the Cr-based eGFR. 

Long-term follow-up 

Of 16 patients, 13 were followed in March 2021. Three patients were lost to follow-up after they moved to a distant place. Follow-up duration after re-induction therapy ranged from 18 to 57 months (median, 29 months; IQR, 18-45 months). No patients presented with significant proproteinuria or had CysC-based eGFR < 90 mL/min/1.73m2.

Table 4. Incidence of acute kidney injury (AKI) by type of chemotherapy course and regimen in pediatric acute lymphoblastic leukemia/ lymphoblastic lymphoma (ALL/LBL).

Post hoc power analysis 

A post hoc power analysis was conducted using G*Power 3.1.9.4 (Heinrich-Heine University, Düsseldorf, Germany) to evaluate the primary outcome of time to AKI diagnosis (Faul et al. 2007). The effect size of our data was 0.609. When the significance level α was set to 0.05, the power was 0.855, which was greater than 0.80. Therefore, the analysis confirmed that the sample size was sufficiently large for statistical analysis (Cohen 1992).

Fig. 1. Comparison of days from the start of chemotherapy to acute kidney injury (AKI) diagnosis. The median number of days to AKI (≤ 25% of reduction in CysC-based eGFR) was 8 days (interquartile range, 4 to 21 days), compared with 17 days (interquartile range, 10 to 31 days) in Cr-based eGFR (p < 0.001). The horizontal lines in the boxes represent the median values, and the bottom and top areas of the boxes represent the 25th and 75th percentiles, respectively. The vertical lines extend from the box to the 5th and 95th percentiles. AKI, acute kidney injury; Cr, creatinine; CysC, cystatin C; eGFR, estimated glomerular filtration rate.