A Comparison of Measured Creatinine Clearance versus Calculated Glomerular Filtration Rate for Assessment of Renal Function before Autologous and Allogeneic BMT

Abstract

Common blood and marrow transplantation (BMT) eligibility criteria include a minimum glomerular filtration rate (GFR) that may vary by regimen intensity. GFR is often estimated by measurement of creatinine clearance in a 24-hour urine collection (24-hr CrCl), an inconvenient and error-prone method that overestimates GFR. The study objectives were to determine which of 6 GFR calculations: Cockroft-Gault (CG), modified CG (mCG), Modification of Diet in Renal Disease 1 (MDRD1), MDRD2, Jelliffe, and Wright, consistently underestimated measured 24-hr CrCl pre-BMT. We retrospectively analyzed 98 consecutive allogeneic (n = 48) or autologous (n = 50) adult BMT patients from January 2006 to April 2007. All 6 formulas were significantly (P < .001) correlated with 24-hr CrCl with R = 0.64 (Wright), 0.63 (CG), 0.61 (mCG), 0.61 (Jelliffe), 0.54 (MDRD2), and 0.50 (MDRD1). When compared to the measured 24-hr CrCl, MDRD2 consistently underestimated it in the highest proportion of patients (66%, P < .001), compared with MDRD1 (65%, P < .001), Jelliffe (61%, P = NS), mCG (55%, P = NS), Wright (34%, P < .001), and CG (34%, P = .001). Measured 24-hr CrCl, pre-BMT serum Cr, and all 6 equations were not predictive of renal regimen-related toxicity (RRT) post-BMT. The Wright and CG formulas are closest to, but overestimate 24-hr CrCl in 66% of patients. In comparison, MDRD2 consistently underestimates 24-hr CrCl in 66%. Although MDRD2 is the most conservative formula, all 6 formulas gave reasonable estimates of GFR and any of the 6 equations can replace the measured 24-hr CrCl. Larger analyses and transplantation of patients with GFR <50 mL/min may better define subgroups at risk for renal RRT.

Estimation of renal function in lung cancer patients

“…This is not surprising since it is the only equation estimating creatinine clearance and not GFR. Although a previous study shares our observation [19], other studies, comparing the CG estimates to GFR, measured with isotope, found poorer performance of CG compared to other equations [18,22,23]. The MDRD equation did worse in mimicking ECC in our study.…”

“…As reported in previous studies, all overestimated renal function at lower ranges of ECC and underestimated it at higher ranges [19][20][21][22]. Especially in patients with poor renal function, inaccuracies of the used equations (MPE ranging from 21% for CG and 44% for CKD-EPI equation in the ECC range below 50 mL/(min × 1.73 m 2 ), data not shown) can misguide clinical decisions with important implications for patient care; special attention is required in these patients.…”

Weekly nab-Paclitaxel in Combination With Carboplatin as First-Line Therapy in Patients With Advanced Non–Small-Cell Lung Cancer: Analysis of Safety and Efficacy in Patients With Renal Impairment

“…Although numerous methods for predicting GFR exist, studies have demonstrated that CrCl measured by the Cockcroft-Gault equation provides reasonable estimates of GFR. 26 A large study of 973 patients found that estimates of renal function using the Cockcroft-Gault method were in general agreement with estimates using the newer Modification of Diet in Renal Disease method. 27 Furthermore, the Cockcroft-Gault equation was developed to predict CrCl rather than GFR, and its accuracy has been evaluated in numerous studies.…”

“…27 Furthermore, the Cockcroft-Gault equation was developed to predict CrCl rather than GFR, and its accuracy has been evaluated in numerous studies. [26][27][28][29][30] Another potential limitation is the differences in the measurement of renal function between Japan and all other countries; however, only 14% of all patients in the ITT population were from Japan. 13 Thus, the outcomes observed in this analysis were not likely to be affected by this.…”

Estimating GFR in Adult Patients with Hematopoietic Cell Transplant

“…Hazar et al (33) found no correlation between the estimating equations and their radiolabeled GFR measurement. Other studies in the HCT population have assessed whether estimating equations correlate with 24-hour urine collection for Cr clearance (34).…”