Assessment of Glomerular filtration rate profiles of Paediatric patients on Cancer Chemotherapy at the Kenyatta Naional Hospital

Abstract

Background: An accurate estimation of renal function in children is important in optimizing the dose of many drugs used in paediatric oncology, and allows clinical monitoring of the nephrotoxic effects of cytotoxic agents such as cisplatin. Assessment of the glomerular filtration rate (GFR) is widely accepted as the best index of renal function in patients. Objective: To determine the glomerular filtration rate profiles of paediatric oncology patients on cancer chemotherapy at the Kenyatta National Hospital. Secondary objective was to assess the changes in glomerular filtration rates that have occurred over at least 6 months following cancer chemotherapy. Study design: Cross sectional survey Settineg: Kenyatta National Hospital General Paediatric wards, including Paediatric Oncology and Paediatric Ophthalmology ward. Study population: Paediatric patients who had an established diagnosis of cancer and had been on chemotherapy for at least 6 months Study method: Chart reviews of oncology patients in general paediatric wards, ophthalmology ward and hematology clinic were done.A total of 115 patients aged upto 12 years who had an established diagnosis of cancer and had been on cancer chemotherapy for at least 6 months were recruited from the wards. Biodata and pretreatment creatinine measurements were recorded. Creatinine clearance was calculated from measured serum creatinine using the Schwartz formula. Estimated glomerular filtration rates were tabulated. Results: Out of the 115 children enrolled in the study 43 had abnormal kidney function. This gave a prevalence of 37% (95%CI 28-46).The other 72 children had normal kidney function. Patients aged less than 5yrs and those with solid tumors had a hiher likelihood of having an abnormal GFR compared to their older counterparts and those with lymphomas and leukemias Conclusions:Monitoring of GFR should be done regulary as decline occurs as one continues on chemotherapy especially for the ones below 5yrs and those with solid malignancies