Reliability of estimated glomerular filtration rate in patients treated with platinum containing therapy

Lauritsen, Jakob; Gundgaard, Maria Gry; Mortensen, Mette Saksø; Oturai, Peter; Feldt‐Rasmussen, Bo; Daugaard, Gedske

doi:10.1002/ijc.28816

Cited by 22 publications

(7 citation statements)

References 39 publications

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“…Post-CT mGFR decreased in comparison to pretreatment mGFR, a median of 9 mL/min after 3 cycles, 14 mL/ min after 4 cycles and 20 mL/min after +5 cycles. All eGFR estimates, by the MDRD, Wright and CKD-EPI equations, except for the CG equation, increased significantly after CT. During follow-up at 1, 3, and 5 years, all estimates decreased and mGFR increased significantly [27].…”

Section: Drug Dosing In Cancer Patientsmentioning

confidence: 99%

Drug Dosing and Estimated Renal Function - Any Step Forward from Effersoe?

Hornum

Feldt‐Rasmussen²

2017

Nephron

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Drug dosing in accordance with the renal function is a long-standing challenge to clinicians. For many years it has been evident that in many clinical situations there is no easy way to correctly dose any drug that is mainly cleared by the kidneys. Despite the development of many formulas for estimating the glomerular filtration rate, they all have serious shortcomings. Much effort has been put in to develop estimation formulas to evaluate the renal function as an alternative to direct methods with the aim of safely dosing drugs that are mainly cleared by the kidneys. Both creatinine- and cystatin C-based formulas with additional clinical and biochemical parameters deduced from association studies with methods to measure the glomerular filtration rate (mGFR) have been developed. None of them have been good enough to perform safely in the wide range of situations in daily clinical praxis. Despite serious limitations, there has also been a tendency to use estimated GFR (eGFR) as a “hard” clinical endpoint in clinical studies. This has increased the risk of misinterpretation and has led to conclusions that are not necessarily supported by data. Finally, new methods of testing drug toxicity and the use of pharmacological support in order to fix the right doses are mentioned in this short overview of studies; possible problems that are encountered using eGFR instead of mGFR in the clinic and in research are also mentioned in this report.

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Section: Drug Dosing In Cancer Patientsmentioning

confidence: 99%

Drug Dosing and Estimated Renal Function - Any Step Forward from Effersoe?

Hornum

Feldt‐Rasmussen²

2017

Nephron

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“…There have been some reports about the accuracy of these creatinine-based eGFR formulae in oncology patients. However, most of them showed that the performance of the eGFR formulae were unacceptable and thus the precision of chemotherapy dosing was low in some oncology patients [9][10][11]. Such inaccuracy may result in severe side effects, including death.…”

Section: Introductionmentioning

confidence: 99%

A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients

et al. 2020

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Background: Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to assess the agreement of eGFR formulae and thereby build a nomogram to predict the reliability of estimates. Methods: Measured GFR (mGFR) using isotope from 445 oncology patients were compared with eGFR from six formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), modified MDRD formulae for Chinese (C-MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration, Wright and full age spectrum (FAS)). Bias, precision and accuracy of eGFR formulae were examined. We also evaluated statistics of agreement: the total deviation index (TDI), the concordance correlation coefficient (CCC) and the coverage probability (CP). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram. Results: All eGFR formulae tended to overestimate the eGFR. The percentage of patients with eGFR within 30% the mGFR ranged from 38.0 to 62.8%. Cockcroft-Gault and MDRD showed low bias and high precision. The MDRD formula exhibited lowest TDI, meaning that 90% of estimations ranged from − 36 to 36% of mGFR. Multivariate logistic regression showed that inaccuracy of MDRD was found in elderly patients or in patients with eGFR greater than 120 ml/min. A nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement. Conclusions: Our results suggest that the error of eGFR by any formulae was common and wide in Chinese oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.

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“…There have been some reports about the accuracy of these creatinine-based eGFR formulae in oncology patients. However, most of them showed that the performance of the eGFR formulae were unacceptable and thus the precision of chemotherapy dosing was low in some oncology patients [7][8][9]. Such inaccuracy may result in severe side effects, including death.…”

Section: Introductionmentioning

confidence: 99%

A novel nomogram to predict the reliability of estimated glomerular filtration rate formula in oncology patients

Cheng

Huang

Han

et al. 2019

Preprint

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Background Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely used in oncology patients, however, they are inaccurate in some populations. Our aim was to identify population characteristics where eGFR formulae performed poorly and thereby build a nomogram to predict the reliability of estimates. Methods Measured GFR (mGFR) using isotope from 444 oncology patients were compared with eGFR from four formulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration and Wright). Multivariate logistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive nomogram. Results The Cockcroft–Gault formula exhibited estimates with lowest bias and highest precision. Nonetheless, it was still unreliable in a relevant proportion of patients. The percentage of patients within 30%, 20%, and 10% of the accurate percentage error (APE) was seen in only 62.8%, 47.7% and 24.8% of patients respectively. Inaccuracy was found in overweight patients or in patients with BUN/Scr ratio greater than 20 or with eGFR greater than 120 ml/min. A novel nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The calibration curve showed good agreement. Conclusions Our results suggest that all eGFR formulae tend to overestimate the eGFR in oncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed.

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Reliability of estimated glomerular filtration rate in patients treated with platinum containing therapy

Cited by 22 publications

References 39 publications

Drug Dosing and Estimated Renal Function - Any Step Forward from Effersoe?

Drug Dosing and Estimated Renal Function - Any Step Forward from Effersoe?

A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients

A novel nomogram to predict the reliability of estimated glomerular filtration rate formula in oncology patients

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