Abstract
e14074 Background: The glomerular filtration rate (GFR) is essential for carboplatin chemotherapy dosing, however, the best method to estimate GFR in patients with cancer is unknown. We identify the most accurate and least biased method. Methods: Data on age, sex, height, weight, serum creatinine, and results for GFR from 51Cr-EDTA excretion measurements (51Cr-EDTA GFR) were obtained from Caucasian patients aged 18 years or older with histologically confirmed cancer diagnoses at the University of Cambridge Hospital NHS Trust, UK. We developed a new multivariable linear model for GFR using statistical regression analysis. 51Cr-EDTA GFR was compared to the estimated GFR (eGFR) from seven published and our new model using an internal validation data set and root-mean-squared-error (RMSE) and median residuals. A comparison of carboplatin dosing accuracy based on an absolute percentage error more than 20% (APE > 20%) was undertaken. Results: Between August 2006 and January 2013 data from 2,471 patients were obtained. The new model improved the eGFR accuracy (RMSE 15.00ml/min (95% CI 14.12-16.00)) compared to all published models. Body surface area (BSA) adjusted CKD-EPI was the most accurate published models for eGFR (RMSE 16.30ml/min (95% CI 15.34-17.38)) for the internal validation set. Importantly, the new model reduced the fraction of patients with a carboplatin dose APE > 20% to 14.17% in contrast to 18.62% for BSA adjusted CKD-EPI and 25.51% for the Cockcroft-Gault model. The results were externally validated. Conclusions: In a large data set, from patients with cancer, a new model improves eGFR and carboplatin dose calculations, when compared to BSA adjusted CKD-EPI, the model we identified as the best published model for determination of eGFR in patients with cancer.
Highlights
The glomerular filtration rate (GFR), the fluid volume filtered from the capillaries of the renal glomeruli into the Bowman’s capsule per unit time, is used for calculations of carboplatin chemotherapy doses.[1]
We developed a new multivariable linear model for GFR using statistical regression analysis. 51Cr-EDTA GFR was compared with the estimated GFR from seven published models and our new model, using the statistics root-mean-squared-error (RMSE) and median residual and on an internal and external validation data set
The new model improved the estimated GFR (eGFR) accuracy (RMSE, 15.00 mL/min; 95% CI, 14.12 to 16.00 mL/min) compared with all published models
Summary
The glomerular filtration rate (GFR), the fluid volume filtered from the capillaries of the renal glomeruli into the Bowman’s capsule per unit time, is used for calculations of carboplatin chemotherapy doses.[1]. Models for GFR estimation have been developed on the basis of readily available data, such as serum creatinine concentrations, age, and sex of the patient.[3,4,5,6,7,8,9,10,11]. These published models for GFR have been mainly developed for noncancer patient populations that are frequently enriched for patients with chronic kidney disease. Their usefulness in patients with cancer has been examined using only small data sets, and limitations have been documented.[12,13,14,15,16]
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