Prevalence of renal insufficiency in cancer patients: Data from the IRMA-2 study

Abstract

9559 Background: The IRMA-1 study reported the high prevalence of renal insufficiency (RI) in 4,684 cancer patients, with a glomerular filtration rate (GFR) <90 and <60 ml/min/1.73m2 for 52.9% and 12.0%, respectively. Furthermore, almost 80% of patients were receiving nephrotoxic drugs or drugs necessitating dosage adjustment. The IRMA-2 study was started one year later, in different patients, and consisted of 2 phases: 1) a cross-sectional study, similar to IRMA-1, and 2) a 2-year retrospective follow-up of the patients to describe the evolution of their renal function along with time. Data from the phase 1 were compared to the results of IRMA-1 in terms of RI prevalence. Methods: Data were collected for cancer patients presenting at one of the 19 IRMA-2 centers in March 2005: type of tumour, sex, age, weight, serum creatinine (SCR), and anticancer drugs. Dialysis, myeloma and lymphoma patients were not included. The prevalence of SCR>110 μmol/L was assessed. GFR was estimated with the aMDRD formula, anticancer drugs necessitating dosage adjustment and those potentially nephrotoxic were identified. Results: 4,945 patients (breast 1816, colorectal 747, lung 463, ovarian 294, prostate 251) were included in the IRMA-2 study. Median age 60.0, mean weight 66.2, 62.8% were women. The prevalence of an elevated SCR (SCR>110μmol/l) was 7.2% (vs. 7.2% in IRMA-1), that of a GFR < 90 ml/min/1.73m2 was 50.2% (vs. 52.9%) and that of a GFR < 60 ml/min/1.73m2 was 11.9% (vs. 12.0%) ( Table ). 73.2% of treated patients (n=3882) were receiving at least one drug needing dosage adjustment and 75.5% received at least one nephrotoxic drug (vs. 79.9 and 80.1%, respectively). Conclusions: The results of IRMA-2 and IRMA-1 confirm the high prevalence of RI in cancer patients, on 2 different cohorts of nearly 5,000 cancer patients each. This underlines that estimating renal function in cancer patients is mandatory and that this highly frequent co-morbidity should be considered. [Table: see text] No significant financial relationships to disclose.

Onconephrology: The intersections between the kidney and cancer

“…In fact, carboplatin is unique among chemotherapeutic agents, in that its dosing is largely based on determination of the eGFR 18 . Highlighting the prevalence of this issue were the Renal Insufficiency and Anticancer Medications (Insuffisance Renale et Medicaments Anticancereux [IRMA]) studies, in which 79.9% of patients received at least one drug that required dose modification for kidney function, and 80.1% of patients received at least one anticancer drug with significant nephrotoxicity risk potential 1,19 …”

Chronic Kidney Disease as a Complication of Cancer

“…A few large-scale observational studies in Europe have systematically examined the prevalence of CKD among patients with solid tumors. The Renal Insufficiency and Anticancer Medications (IRMA)-1 and −2 are French national observational studies which included about 5,000 cancer patients each (4,684 patients in IRMA-1 and 4,945 in IRMA-2), representing mainly breast, colorectal, lung, ovarian, and prostate cancers (1, 2). About half of the patients in each trial had nonmetastatic disease, and none of them were on dialysis at the time of enrollment.…”

“…Several studies have assessed the impact of CKD on mortality in cancer patients. In the IRMA-2 study, patients with eGFR <60 mL/min/1.73 m 2 had a lower survival rate through 2 years of follow-up than patients with eGFR ≥60 mL/min/1.73 m 2 (16.4 vs. 25 months), independent of the cancer type (2).…”

“…This is evident in the observations that cancer and/or its treatments can lead to CKD, and that CKD is a risk factor for cancer development. A number of observational studies have shown the high prevalence of CKD in patients with solid tumors (1-2-3-4). CKD is also frequent in hematopoietic cell transplantation (HCT) recipients (5-6-7-8) and multiple myeloma patients (9-10-11-12).…”

Introduction to the Journal of Onco-Nephrology

“…These two cohorts included about 10,000 adult cancer patients with solid tumors (mainly breast, colorectal, and lung). Approximately half of them were nonmetastatic at the time of inclusion, and not on dialysis (1, 2). In these cohorts, 52.9% and 50.2% of the patients in IRMA-1 and IRMA-2, respectively, had a reduced eGFR (lower than 90 mL/min/1.73 m²), and 12.0% and 11.8% had stage 3 or 4 RI (lower than 60 mL/min/1.73 m²).…”