GFR Measurement and Chemotherapy Dosing in Patients with Kidney Disease and Cancer

Abstract

Chemotherapeutic agents require precise dosing to ensure optimal efficacy and minimize complications. For those agents that are removed from the body by the kidney, accurate knowledge of GFR is critical. In addition, GFR needs to be determined rapidly, easily, and, if possible, with little additional cost. The ability to easily measure GFR also allows for rapid detection of nephrotoxicity. Current methodologies include direct clearance measurement of an indicator substance or estimation of creatinine clearance or GFR through regression equations that use a serum marker, such as creatinine or cystatin C. These methodologies all have shortfalls and limitations, some of which are specific to the patient with cancer. Newer methodologies that directly measure GFR are in clinical trials and offer the ability to rapidly and noninvasively provide accurate estimates of drug clearance as well as detection of nephrotoxicity. These methods offer the opportunity to refine drug dosing and improve outcomes.

Assessment of kidney function: clinical indications for measured GFR

“…Although GFR equations based on cystatin C perform better than creatinine-based equations [ 32 ], cystatin C failed to detect a decrease in GFR following chemotherapy for lung cancer in a study by Oc et al [ 33 ]. Also, cystatin C has been questioned for the determination of GFR and the detection of nephrotoxicity in oncology patients due to possible GFR-independent effects of the underlying malignancy and chemotherapy on cystatin C levels [ 24 ]. Liang et al [ 34 ] analysed the effect of high-dose prednisone on the prediction of AKI on admission to the intensive care unit.…”

“…Sweden certainly has a pioneering role within Europe, as measurement of GFR is routinely performed in many patients with advanced CKD, demonstrating that accurate measurement of kidney function is feasible and can be easily implemented [ 23 ]. Whether newer, real-time methods to measure GFR [ 24 ] or improved eGFR assessment based on a panel of novel filtration markers [ 25 ] will be more advantageous than plasma clearance methods of exogenous markers such as iohexol in the clinical setting cannot be answered at present, as these methods have not yet been established for non-scientific use.…”

Prevalencia de gérmenes con multirresistencia antibiótica en bacteriemia asociada a neutropenia febril en pacientes oncológicos hospitalizados

“…Asimismo, tiene semejanza al estudio de caracterización de las infecciones en pacientes adultos con cáncer tratados con quimioterapia en el hospital "José Carrasco Arteaga" de Cuenca -Ecuador, se demuestra que presentó una mayor prevalencia de gérmenes MDR en mujeres, con edades entre 61 a 80 años. En este caso las infecciones más frecuentes fueron de tipo bacteriana, en la cual los microorganismos mayormente involucrados son los bacilos Gram negativos como la Escherichia coli y cocos gram positivos como el Estafilococcus aureus; el sitio de infección usualmente fue el tracto urinario [16].…”

Comparison of Equations To Estimate Glomerular Filtration Rate and Their Impact on Frequency of Cisplatin-associated Acute Kidney Injury

“…While this indexing has helped improve their accuracy over the CG equation for estimating GFR, it can still be a suboptimal for patients with BSAs that differ widely from 1.73 m 2 . 34 We, therefore, adjusted the eGFR to the patients' own BSA. However, our results were mixed, and the BSA-adjusted equations did not substantially outperform eGFRCKD-EPI for predicting C-AKI.…”