Racial, Ethnic, and Neighborhood Disparities in Acute Kidney Injury in Pediatric Acute Leukemia

INTRODUCTION: We sought to identify racial/ethnic and neighborhood disparities in acute kidney injury (AKI) in children with acute lymphoblastic or myeloid leukemia (ALL, AML). METHODS: Electronic health record data were retrospectively collected from patients treated for de novo pediatric ALL or AML in the multicenter Leukemia Electronic Abstraction of Records Network. AKI was defined by modified Kidney Disease Improving Global Outcomes criteria. Neighborhood-level resources were defined by the Child Opportunity Level (COL). Prevalence ratios (PRs) for AKI at diagnosis by race/ethnicity and COL were calculated using modified Poisson regression. Cox regression was used to calculate hazard ratios (HRs) of first AKI after initiation of chemotherapy (i.e., "during therapy"). RESULTS: Of 952 ALL patients, Non-Hispanic Black (NHB) ALL patients had significantly increased prevalence of AKI at leukemia diagnosis compared to Non-Hispanic White (NHW) patients in the adjusted model (PR 1.50); there were no significant differences by COL. During ALL therapy overall, NHB patients did not have any significant differences in hazard of AKI by race/ethnicity or COL in adjusted models. Among 168 AML patients, there were no significant differences in AKI at diagnosis by race/ethnicity or COL in AML. During AML therapy overall, NHB patients had significantly higher risk of AKI in both unadjusted (HR 1.95) and adjusted (HR 2.68) models, but no differences by COL. CONCLUSION: NHB patients with ALL had increased risk of AKI at the time of leukemia diagnosis, and NHB patients with AML had significantly increased risk of AKI during therapy. Further studies to identify drivers and interventions that mitigate AKI risk are warranted.