Prediabetes in Childhood Cancer Survivors Ups Cardiovascular, CKD Risks – Renal and Urology News

Prediabetes and diabetes frequently develop in adult survivors of childhood cancer and at younger ages than their healthy peers, which increases their risks for chronic kidney disease (CKD), cardiovascular events, and early death, a new study finds.

According to Stephanie B. Dixon, MD, MPH, of St Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues, “new onset of diabetes in survivors is a critical marker identifying a high-risk state.”

Using data from the St Jude Lifetime Cohort Study (SJLIFE), the investigators compared 3529 adults diagnosed with childhood cancer at least 5 years prior to study inclusion and 448 age-matched healthy adults. Prediabetes and diabetes occurred in 29.2% and 6.5% of cancer survivors compared with 18.1% and 4.7% of healthy adults, respectively.

By age 40-49 years, prediabetes (45.5%) or diabetes (14.0%) affected more than half of childhood cancer survivors. Over a median 5.1 years, 10% progressed from prediabetes to diabetes. In analyses, radiation exposure to the pancreatic tail of 10 Gy or more and total-body irradiation were significantly associated with a 2.7- and 4.4-fold increased risk of prediabetes progression, respectively, Dr Dixon’s team reported in the Journal of Clinical Oncology.

Survivors with prediabetes had a significant 2.4- and 2.9-fold increased risk of a future myocardial infarction and CKD, respectively, compared with survivors with normal glucose levels in adjusted analyses, the investigators reported. Survivors with diabetes had a 3.8- and 3.4-fold increased risk of future cardiomyopathy or stroke, respectively and a 2.3- and 2.6-fold increased risk of death from any cause or health-related causes, respectively.

“We have identified that prediabetes and diabetes each increase risk of future cardiovascular events and CKD in survivors, independent of cancer treatment and other traditional cardiovascular risk factors,” Dr Dixon’s team wrote.

They added, “On the basis of these findings, it is now clear that future interventions are needed to target prediabetes as a modifiable risk factor and determine the optimal strategy for prevention of diabetes and subsequent early morbidity and mortality.”