Staff Nephrologist Jim Pattison Children's Hospital Jim Pattison Children's Hospital Saskatoon , Saskatchewan, Canada
Background: Tumor lysis syndrome (TLS) is a common oncologic emergency among patients with pediatric hematologic malignancies. Biochemical derangements from TLS can lead to significant sequelae including acute kidney injury (AKI), arrhythmias, seizures, and sudden death. The mainstay of TLS management is aggressive intravenous (IV) hydration. However, the burden of fluid overload (FO) and AKI within this population is understudied. In this study, we aim to describe the incidence, severity and complications of FO and AKI among pediatric patients with TLS.
Design/Methods: Our retrospective single center cohort study involved pediatric patients aged 1-18 years with a new diagnosis of hematologic malignancy over a 10-year period including acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL). Patients who met criteria for TLS were analyzed in two groups based on the severity of FO and AKI. Patients with severe AKI ( ≥2x increase in serum creatinine) were compared to those with no/mild AKI (< 2x increase in serum creatinine). Patients with severe FO ( ≥10%) were compared with those with mild/moderate FO (< 10%). Charts were reviewed for complications associated with AKI and FO including hypoxemia, mechanical ventilation, hyponatremia, pulmonary edema, intensive care admission and need for renal replacement therapy (RRT).
Results: We identified 56 patients with TLS. We found severe FO occurred in 35.7% (n=20) and was more common in younger children (3.5 vs 6.5 years, p=0.004) with a primary diagnosis of Burkitt lymphoma (25% vs. 2.8%, p=0.01). PICU admission occurred in 35% of patients with severe FO compared to 8% in those with mild/moderate FO (p=0.013). Complications of hypoxemia (30% vs. 5.6%, p=0.012) and pulmonary edema (25% vs. 2.8%, p=0.01) were more common among those with severe FO. AKI occurred in 37.5% (n=21) patients and resulted in a significant increase in PICU admission and requirement for RRT (p=0.001 and p <0.001, respectively). Conclusion(s): To our knowledge, this is the first pediatric study to examine the incidence and outcomes of FO and AKI among TLS patients. Our results show FO and AKI are common and often unrecognized complication of TLS associated with increased morbidity. Prospective, multi-center studies are needed to further dissect the burden of FO and AKI within this vulnerable population.
Comparison of patient outcomes associated with %FO and AKI
Authors/Institutions: Kayla Flood, BC Children's Hospital, Vancouver, British Columbia, Canada; Jacob Rozmus, BC Children's Hospital, Vancouver, British Columbia, Canada; Peter Skippen, BC Children's Hospital, Vancouver, British Columbia, Canada; Douglas Matsell, BC Children's Hospital, Vancouver, British Columbia, Canada; Cherry Mammen, BC Children's Hospital, Vancouver, British Columbia, Canada