A comparison of bedside renal function estimates and measured glomerular filtration rate (Tc99mDTPA clearance) incancer patients

Poole, Susan; Dooley, Michael; Rischin, Danny

doi:10.1093/annonc/mdf236

Cited by 55 publications

(32 citation statements)

References 24 publications

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“…6 -8 However, in several studies in nonrenal patient populations, their predictive performance was disappointing. 9,10 Although several important studies in CHF used renal function estimations by creatinine-based formulas, none of these formulas have been validated in a wide range of CHF patients. A number of factors specific to this group of patients may influence the accuracy and precision of these formulas, such as the predominantly hemodynamic nature of renal function impairment, medication interfering with renal function, sodium retention leading to volume expansion, and loss of muscle mass due to inactivity.…”

Section: Clinical Perspective P 1580mentioning

confidence: 99%

Drawbacks and Prognostic Value of Formulas Estimating Renal Function in Patients With Chronic Heart Failure and Systolic Dysfunction

et al. 2006

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Background-Renal function is an important risk marker for morbidity and mortality in chronic heart failure (CHF) and is often estimated with the use of creatinine-based formulas. However, these formulas have never been validated in a wide range of CHF patients. We validated 3 commonly used formulas estimating glomerular filtration rate (GFR) with true GFR in CHF patients. Furthermore, we compared the prognostic value of these formulas for cardiovascular outcome with that of true GFR during 12 months of follow-up. Methods and Results-In 110 CHF patients (age, 57Ϯ11.7 years; left ventricular ejection fraction, 0.27Ϯ0.09; NYHA class, 2.5Ϯ0.9), we measured 125 I-iothalamate clearance. Cockcroft-Gault (GFR cg ), Modification of Diet in Renal Disease (MDRD), and simplified MDRD (sMDRD) equations were used as creatinine-based renal function estimations. Furthermore, 24-hour creatinine clearance (CrCl) was determined. CrCl and GFR cg were the most accurate. MDRD was most precise formula, although it was also highly biased. All formulas overestimated in the lower ranges and underestimated in the upper ranges of the GFR corrected for body surface area. The predictive performance of the formulas was best in severe CHF (NYHA classes III and IV). The prognostic value of CrCl and MDRD for cardiovascular outcome was comparable to that of GFR, the sMDRD was slightly less, and the GFR cg had a significantly worse prognostic value. Conclusions-In the more severe ranges of CHF, creatinine-based formulas and CrCl corrected for body surface area appeared to be more precise and accurate in estimating true GFR corrected for body surface area. The MDRD formula is the most precise and has a good prognostic value, whereas the sMDRD is slightly less accurate but uses fewer parameters, which makes this formula a practical alternative in clinical practice.

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Section: Clinical Perspective P 1580mentioning

confidence: 99%

Drawbacks and Prognostic Value of Formulas Estimating Renal Function in Patients With Chronic Heart Failure and Systolic Dysfunction

et al. 2006

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“…Moreover, the Martin equation, developed to predict GFR in cancer patients, underestimates GFR in females and overestimates GFR in males (Poole et al 2002). It was suggested that in elderly cancer patients the Wright equation may be the most accurate, precise and least biased equation for the calculation of GFR higher than 50 ml/min (Marx et al 2004).…”

Section: Creatinine Clearance Through 24-h Urine Collection or Mathemmentioning

confidence: 99%

Accurate measurement of individual glomerular filtration rate in cancer patients: an ongoing challenge

Holweger

Bokemeyer

Lipp

2005

J Cancer Res Clin Oncol

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A narrow therapeutic index is a characteristic feature of cytotoxic agents. Some of these agents are almost entirely eliminated renally in unchanged active form. As a consequence, assessment of the individual glomerular filtration rate (GFR) may help to predict the pharmacokinetic behaviour of cytotoxic agents in plasma more precisely. In addition, GFR-adapted individualization of cancer chemotherapy may have an enormous impact on the severity of side effects. Several methods are available to determine GFR or creatinine clearance (CrCl). GFR-measurement based on experimental methods with radiolabelled isotopes, contrast media or inulin helps to reflect the real situation very closely. In addition, 24-h urine collection is a convenient and feasible method to measure creatinine clearance. Finally, several mathematical equations exist to estimate GFR or CrCl based on serum creatinine and other parameters. Only a few of these equations have been developed in oncologic patients. However, some of these equations are routinely used in clinical practice, because they allow a rapid estimation of GFR. Based on the fact that clinically relevant differences have been assessed between calculated values and the real situation, mathematical calculation of GFR or CrCl does not seem to be appropriate to assess individual renal function precisely enough over a broad range of individual GFR or CrCl. Whether the measurement of low-molecular-weight proteins, such as cystatin C and ss-trace protein, may help to reflect the real situation more precisely is a matter of controversial debate.

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“…For this reason, approaches based on nonlinear mixed effects models, often referred to as population models, have recently been published and independently assessed (Martin et al, 1998;Wright et al, 2001;Poole et al, 2002;Léger et al, 2002). These methods involve the use of patient specific 51 Cr-EDTA plasma data together with supplementary covariate information.…”

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confidence: 99%

Estimation of glomerular filtration rate in paediatric cancer patients using 51CR-EDTA population pharmacokinetics

et al. 2004

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Estimation of glomerular filtration rate (GFR) using the clearance of chromium 51 EDTA ( 51 Cr-EDTA) (or other radiolabelled isotopes) is reliable, but invasive and not always practicable. Mathematical models have been devised for estimating GFR using readily obtainable patient characteristics. Unfortunately, these models were developed using various patient populations and may not provide the optimal prediction of GFR in children with cancer. The current study uses population pharmacokinetics to determine the relationship between 51 Cr-EDTA clearance, and patient covariates in 50 paediatric cancer patients. These models were validated using a separate group of 43 children and were compared with previously published models of renal function. Body size was the major determinant of 51 Cr-EDTA clearance and inclusion of weight or surface area reduced the residual variability between individuals (coefficient of variation) from 61 to 32%. Serum creatinine was the only other parameter that significantly improved the model. Mean percentage error values of -5.0 and -1.1% were observed for models including weight alone or weight and creatinine, respectively, with precision estimates of 21.7 and 20.0%. These simple additive models provide a more rationale approach than the use of complex formulae, involving additional parameters, to predict renal function.

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A comparison of bedside renal function estimates and measured glomerular filtration rate (Tc99mDTPA clearance) incancer patients

Abstract: All the assessed estimates for renal function were found to have significant limitations.

Cited by 55 publications

References 24 publications

Drawbacks and Prognostic Value of Formulas Estimating Renal Function in Patients With Chronic Heart Failure and Systolic Dysfunction

Drawbacks and Prognostic Value of Formulas Estimating Renal Function in Patients With Chronic Heart Failure and Systolic Dysfunction

Accurate measurement of individual glomerular filtration rate in cancer patients: an ongoing challenge

Estimation of glomerular filtration rate in paediatric cancer patients using 51CR-EDTA population pharmacokinetics

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