Background

Over the last few decades, cancer therapy has been improved by the introduction of intensified treatment protocols and advanced supportive therapy. As a consequence, outcomes for children diagnosed with cancer have progressed from an estimated 80% mortality in the late 80’s to an 80% survival at this time. However, these developments have also increased morbidity, including the incidence of disease- or treatment-associated complications, many of which require intensive care treatment.  Renal failure is one of these serious complications.

Relevance for cancer research

Studies on outcome assessment in paediatric cancer and hematopoietic stem cell transplant (HSCT) patients are scarce. Acute kidney injury (AKI) is common in the post-HSCT phase and contributes to morbidity in these critically ill children. Continuous renal replacement therapy (CRRT) has become the most widely used renal support modality for use in the AKI population. A better understanding of the impact of CRRT on short- and long-term outcomes is hence essential for an optimal CRRT implementation. Furthermore, early detection of AKI is critical.  The diagnosis of AKI is currently based on an increase in serum creatine (SCr), which is a marker of glomerular filtration rate (GFR) and the presence of oliguria. Our recently study showed Serum creatinine and oliguria seem to be not sensitive markers for timely detection of AKI in this population. 

Aims

Within this project we will investigate:

• the impact of CRRT on both short and long-term outcomes among these children and factors that influence these outcomes;

• the applicability of non-invasive biomarkers, including extracellular vesicles to identify early AKI in paediatric cancer patients.

Project outcomes

• Raymakers-Janssen PAMA, Leitzinger N, van den Berg G, Nijman J, Triest MI, Kilsdonk E, van Kessel IA, Hanff LM, van Grotel M, Wijnen MHWA, Wösten-van Asperen RM, Lilien MR, van den Heuvel-Eibrink MM, & Fiocco M (2025). Nephrotoxicity and kidney outcomes in pediatric oncology patients. Nephrology Dialysis Transplantation,  gfaf169. doi: 10.1093/ndt/gfaf169

• Raymakers-Janssen PAMA, van den Berg G, Lilien MR, van Kessel IA, van der Steeg AFW, Wijnen MHWA, Triest MI, van Peer SE, Jongmans MCJ, van Tinteren H, Janssens GO, Fiocco M, Wösten-van Asperen RM, & van den Heuvel-Eibrink MM (2025). The incidence and outcome of acute kidney injury during pediatric kidney tumor treatment—a national cohort study. Pediatric Nephrology, 40(7), 2393–2401. doi: 10.1007/s00467-025-06684-7

• Raymakers-Janssen PAMA, Lilien M, Tibboel D, Kneyber MCJ, Dijkstra S, van Woensel, JBM, Lemson J, Cransberg K, van den Heuvel-Eibrink MM & Wösten-van Asperen RM (2019). Epidemiology and Outcome of Critically Ill Pediatric Cancer and Hematopoietic Stem Cell Transplant Patients Requiring Continuous Renal Replacement Therapy: A Retrospective Nationwide Cohort Study. Crit Care Med, 47(11):e893-e901. doi: 10.1097/CCM.0000000000003973

• Raymakers-Janssen PAMA, Lilien M, van Kessel IA, Veldhoen ES, Wösten-van Asperen RM & van Gestel JPJ (2017). Citrate versus heparin anticoagulation in continuous renal replacement therapy in small children. Pediatr Nephrol 32:1971–78. doi: 10.1007/s00467-017-3694-4

Team

• Prof.dr. M. Fiocco, Mathematical Institute Leiden University, Department of Biomedical Data Sciences Leiden University Medical Center & Princess Máxima Center for Pediatric Oncology 

• Dr. M. Lilien, University Medical Center (UMC) Utrecht

• P. Raymakers-Janssen, PhD candidate at the Princess Máxima Center for Pediatric Oncology & Wilhelmina Children’s Hospital 

• Prof. dr. M.M. van den Heuvel-Eibrink, Princess Máxima Center for Pediatric Oncology 

• Dr. R.M. Wösten-van Asperen, University Medical Center (UMC) Utrecht