Abstract
The accuracy of the estimated glomerular filtration rate (eGFR) in cancer patients is very important for dose adjustments of anti-malignancy drugs to reduce toxicities and enhance therapeutic outcomes. Therefore, the performance of eGFR equations, including their bias, precision, and accuracy, was explored in patients with varying stages of chronic kidney disease (CKD) who needed anti-cancer drugs. The reference glomerular filtration rate (GFR) was assessed by the 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) plasma clearance method in 320 patients and compared with the GFRs estimated by i) the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, ii) the unadjusted for body surface area (BSA) CKD-EPI equation, iii) the re-expressed Modification of Diet in Renal Disease (MDRD) study equation with the Thai racial factor, iv) the Thai eGFR equation, developed in CKD patients, v) the 2012 CKD-EPI creatinine-cystatin C, vi) the Cockcroft-Gault formula, and vii) the Janowitz and Williams equations for cancer patients. The mean reference GFR was 60.5 ± 33.4 mL/min/1.73 m2. The bias (mean error) values for the estimated GFR from the CKD-EPI equation, BSA-unadjusted CKD-EPI equation, re-expressed MDRD study equation with the Thai racial factor, and Thai eGFR, 2012 CKD-EPI creatinine-cystatin-C, Cockcroft-Gault, and Janowitz and Williams equations were −2.68, 1.06, −7.70, −8.73, 13.37, 1.43, and 2.03 mL/min, respectively, the precision (standard deviation of bias) values were 6.89, 6.07, 14.02, 11.54, 20.85, 10.58, and 8.74 mL/min, respectively, and the accuracy (root-mean square error) values were 7.38, 6.15, 15.97, 14.16, 24.74, 10.66, and 8.96 mL/min, respectively. In conclusion, the estimated GFR from the BSA-unadjusted CKD-EPI equation demonstrated the least bias along with the highest precision and accuracy. Further studies on the outcomes of anti-cancer drug dose adjustments using this equation versus the current standard equation will be valuable.
Highlights
The coexistence of chronic kidney disease (CKD) and cancer is common due to the increased incidence of cancer in patients with CKD1 and the fact that CKD worsens the mortality rate of cancer patients[2]
The median 99mTc-DTPA clearance was 50.4 mL/min/1.73 m2, with almost 80% of patients categorized with stages G1–G3b of chronic kidney disease (CKD) according to the KDIGO classification
Our study showed that the body surface area (BSA)-unadjusted CKD-EPI equation showed the best performance for GFR estimation in terms of both precision and accuracy, followed by the CKD-EPI equation as well as the Janowitz and Williams equation for patients with cancer, the Cockcroft-Gault equation, and the Thai estimated glomerular filtration rate (eGFR) equations
Summary
The coexistence of chronic kidney disease (CKD) and cancer is common due to the increased incidence of cancer in patients with CKD1 and the fact that CKD worsens the mortality rate of cancer patients[2]. In contrast to those with CKD alone, mostly suffer from more severe sarcopenia, resulting in lower SCr (due to less creatinine production) and overestimated GFRs. As such, accurately estimated renal function is likely necessary for the proper adjustment of cancer chemotherapy. The aim of the present study was to investigate the agreement and precision of the currently published eGFR formulae, including the CKD-EPI7, the body surface area (BSA)-unadjusted CKD-EPI, the re-expressed MDRD study equation with the Thai racial factor[10,18], the Thai eGFR10, the 2012 CKD-EPI creatinine-cystatin C13, the Cockcroft-Gault[19], and the most recent cancer patient-derived eGFR equation by Janowitz and Williams[3], compared to the standard GFR measurement by 99mTc-DTPA
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