Comparison of methods to estimate glomerular filtration rate in paediatric oncology patients

Llanos-Paez, Carolina; Staatz, C. E.; Lawson, Rachael; Hennig, Stefanie

doi:10.1111/jpc.13752

Cited by 14 publications

(20 citation statements)

References 40 publications

(120 reference statements)

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“…Such worse performance was somewhat expected because malignancies and inflammation increase the serum levels of B2MG 10 that is probably reason for B2MG-based eGFR equations being the only iGFR-underestimating ones. It should be also noted that eGFR equations specifically developed based on children having malignancies (Brandt, Millisor, Cole weight , Cole Cr ) were not among the best performing equations, similarly to a recent study 7 . The reason for their poor performance could be small dataset 25 , use of iothalamate that exhibits significant tubular secretion 13 for development of the equation 24 or exclusion of often incorporated covariates, such as age and sex, from the equation 23 , in contrast to Lund-Malmo revised and Gao equations 21,22 .…”

Section: Discussionsupporting

confidence: 64%

“…This seemingly contrasts with other studies in children with malignancies that have shown better performance of cystatin C-based or combined (creatinine-and cystatin C-based) compared with solely creatinine-based eG-FR equations 2,9 . However, to the best of our knowledge, previous studies in children with malignancies have not evaluated Lund-Malmö revised equation and Gao equation has been studied only once 7 . In a validation study in children with cancer 7 , Gao equation was the worst performing equation, but the study included younger children with lower renal function than in the equation development dataset on whom Gao equation performed the worse 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Determining the prevalence of GH requires correct measurement of GFR, but the predictive performance of commonly used creatinine-based equations for calculating estimated GFR (eGFR) performs poorly in children with cancer 2,3,7 . Use of biomarkers like cystatin C 8,9 and β 2 -microglobulin (B2MG) 10,11 is possible alternative for estimating GFR, but these may introduce bias, because inflammation increases the concentration of both markers 8,10 and B2MG is further elevated due to malignancies 10 .…”

Section: Introductionmentioning

confidence: 99%

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Glomerular filtration rate in children and young adults with haemato-oncological disease and infection is best described by three-compartmental iohexol model

Soeorg¹,

Karu²,

Saks³

et al. 2021

Preprint

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Background. Children with cancer and infection may develop glomerular hyperfiltration (GH). With the aim to determine the prevalence of GH in children and young adults with haemato-oncological disease and infection we developed population pharmacokinetic model of iohexol. We further aimed to assess the accuracy of estimated glomerular filtration rate (eGFR) equations and single- or two-point measured GFR (mGFR) formulas compared with GFR based on iohexol clearance from our population pharmacokinetic model (iGFR). Procedure. Hospitalized patients (0.5-25 years) with haemato-oncological disease and infection were included if their eGFR was ≥80 mL/min/1.73 m2 at the screening visit. Iohexol plasma concentrations were described by population pharmacokinetic model. Bias, precision and accuracy of 23 eGFR equations and 18 mGFR formulas were calculated. Results. Total of 32 iohexol administrations was performed in 28 patients. Median (range) eGFR was 136 (74-234) mL/min/1.73 m2 and age 15.1 (0.8-26.0) years. Three-compartment model with allometric scaling of central, one peripheral compartment and clearance (with power 0.75) to weight fitted the best. Median (range) iGFR was 103 (68-140) mL/min/1.73 m2. All except one eGFR equation overestimated GFR. Lund-Malmö revised eGFR equation performed the best, followed by Gao equation. Of single- or two-point mGFR formulas 15 overestimated iGFR. Modified Jacobsson formula at 5.5 h performed the best, followed by Fleming formula at 3 h. Conclusions. In children and young adults with haemato-oncological disease and infection renal function is best described by iohexol clearance from three-compartmental pharmacokinetic model, while eGFR equations and single- and two-point mGFR formulas overestimate iGFR.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Glomerular filtration rate in children and young adults with haemato-oncological disease and infection is best described by three-compartmental iohexol model

Soeorg¹,

Karu²,

Saks³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Cystatin C is eliminated mainly by glomerular filtration, correlates with GFR, and it is very sensitive even in mildly impaired kidney function so some studies have suggested it as an ideal GFR marker in pediatric oncology (36) . The validation of the Schwartz formula and the calculations based on serum CysC was done in several studies by comparing them to nuclear scanning methods, which suggest that they are closely correlated to GFR (37)(38)(39) . In our study, we found the strongest correlation between the CysC -GFR and the Schwartz-GFR calculations, and comparison of CrCl and eGFRs revealed positive linear regression lines, which may be used as alternatives to creatinine-based estimations in CCS.…”

Section: Discussionmentioning

confidence: 99%

Examination of Nephrotoxicity in Survivors of Childhood Cancer and Comparison of Methods for Estimating Glomerular Filtration Rate

Erdem¹,

Emir²,

Çakar³

et al. 2021

BUCH

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Objective: Increased survival rates in childhood cancers have led the researchers to focus on long-term side effects and possible risk factors for late nephrotoxicity related to the treatment regimens applied. Our aim is to evaluate drug-induced nephrotoxicity in survivors of childhood cancer and to investigate the compatibility of creatinine clearance with the estimated glomerular filtration rate. Methods: The presence of glomerular and tubular dysfunction has been screened among 59 childhood cancer survivors who had completed their treatment regimens with cisplatin, carboplatin, ifosfamide, and /or high dose methotrexate. Results: The mean age of patients was 10.7±5.5 years (2.5-23), and mean follow-up time was 2.6±2.1 years (0.5-8). Renal dysfunction was detected in 65% of the patients. The most prevalent manifestation of renal dysfunction was decreased glomerular filtration rate (n: 19, 32.2%), and increased urinary β2-microglobulin excretion (n: 12, 20.4%), followed by microalbuminuria (n: 6, 10.1%). Survivors treated with combined chemotherapy regimens (cisplatin, carboplatin, ifosfamide) had significantly lower tubular reabsorption of phosphate than those treated with high dose of methotrexate. The glomerular filtration rate analysis was performed using different methods, and a moderate correlation (r=0.563, p=0.00) was found between estimated glomerular filtration rates calculated according to cystatin-C-based equations and Schwartz formula. Conclusion: Childhood cancer survivors demonstrated a high frequency of renal complications in the current study. We have shown that the calculation of the estimated glomerular filtration rate using the Schwartz formula or cystatin-C-based equations is compatible with the creatinine clearance in this specific patient group. In survivors of childhood cancer who cannot perform 24-hour urine collection, determination of estimated glomerular filtration rate is a more practical approach.

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“…Determining the prevalence of glomerular hyperfiltration requires correct measurement of GFR, but the predictive performance of commonly used creatinine‐based equations for calculating estimated GFR (eGFR) performs poorly in children with cancer 2,3,9 . Use of biomarkers like cystatin C 10,11 and β 2 ‐microglobulin 12,13 is possible alternative for estimating GFR, but these may introduce bias because inflammation increases the concentration of both markers, 10,12 although in case of cystatin C this association is controversial, 14 and β 2 ‐microglobulin is further elevated due to malignancies 12 …”

Section: Introductionmentioning

confidence: 99%

Glomerular filtration rate in children and young adults with haemato‐oncological disease and infection is best described by three‐compartment iohexol model

Soeorg

Karu

Saks

et al. 2021

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background: Children with cancer and infection may develop glomerular hyperfiltration. With the aim to determine the prevalence of glomerular hyperfiltration in children and young adults with haemato‐oncological disease and infection, we developed population pharmacokinetic model of iohexol. We further aimed to assess the accuracy of estimated glomerular filtration rate (eGFR) equations and single‐ or two‐point measured GFR (mGFR) formulas compared with GFR based on iohexol clearance from our population pharmacokinetic model (iGFR). Procedure: Hospitalised patients (0.5–25 years) with haemato‐oncological disease and infection were included if their eGFR was ≥80 ml/min/1.73 m2 at the screening visit. Iohexol plasma concentrations were described by population pharmacokinetic model. Bias, precision and accuracy of 23 eGFR equations and 18 mGFR formulas were calculated. Results: Total of 32 iohexol administrations were performed in 28 patients. Median (range) eGFR was 136 ml/min/1.73 m2 (74–234) and age 15.1 years (0.8–26.0). Three‐compartment model with allometric scaling of central, one peripheral compartment and clearance (with power 0.75) to weight fitted the best. Median (range) iGFR was 103 ml/min/1.73 m2 (68–140). All except one eGFR equation overestimated GFR. Lund–Malmö revised eGFR equation performed the best, followed by Gao equation. Of single‐ or two‐point mGFR formulas, 15 overestimated iGFR. Modified Jacobsson formula at 5.5 hours performed the best, followed by Fleming formula at 3 hours. Conclusions: In children and young adults with haemato‐oncological disease and infection, renal function is best described by iohexol clearance from three‐compartment pharmacokinetic model, while eGFR equations and single‐ and two‐point mGFR formulas overestimate iGFR.

show abstract

Comparison of methods to estimate glomerular filtration rate in paediatric oncology patients

Cited by 14 publications

References 40 publications

Glomerular filtration rate in children and young adults with haemato-oncological disease and infection is best described by three-compartmental iohexol model

Glomerular filtration rate in children and young adults with haemato-oncological disease and infection is best described by three-compartmental iohexol model

Examination of Nephrotoxicity in Survivors of Childhood Cancer and Comparison of Methods for Estimating Glomerular Filtration Rate

Glomerular filtration rate in children and young adults with haemato‐oncological disease and infection is best described by three‐compartment iohexol model

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