Estimation versus measurement of the glomerular filtration rate for kidney function assessment in patients with cancer undergoing cisplatin-based chemotherapy

Marie-Christin Klöckl,Armin Gerger,Florian Posch,Michael Stotz,Sabine Zitta,Tobias Niedrist,Florian Moik,Angelika Terbuch,Herbert Stöger,Martin Pichler,Jakob M Riedl,Thomas Bauernhofer,Claudia Friedl,Joanna Szkandera,Stefanie Mollnar,Alexander R Rosenkranz,Anne-Katrin Kasparek,Gernot Schilcher

doi:10.1038/s41598-020-68010-5

Abstract

Glomerular filtration rate (GFR) assessment is indicated before every administration of cisplatin. The optimal modality for this purpose [GFR measurement by urinary Creatinine Clearance (uCrCl) versus GFR estimation (eGFR) by the CKD-EPI formula versus both] is unclear. We investigated whether eGFR only is safe in this setting. Paired uCrCl and eGFR determinations from 470 cisplatin cycles from 121 patients were analyzed [median age: 55 years; most frequent tumor site: genitourinary (45%); palliative treatment: n = 41 (34%)]. Primary endpoint was the proportion of cycles with uCrCl < 50 ml/min/1.73m2 and eGFR ≥ 50 ml/min/1.73m2 (i.e. a “false negative” result when only determining eGFR). The primary endpoint occurred in 8 of 470 cisplatin cycles (1.7%, 95%CI 0.5–2.9). In all 8 events, uCrCl was lower than eGFR (mean uCrCl vs. eGFR: 43 versus 112 ml/min/1.73m2). The uCrCl was re-measured in all patients, and showed normal results in all but 1 patient. None of these events precluded the administration of cisplatin at the planned date, and no subsequent cases of acute nephrotoxicity occurred. Overall agreement between uCrCl and eGFR was low, with qualitative analysis suggesting frequent incompliance with 24-h urine collection. We conclude that an eGFR is sufficient for assessing kidney function in patients with cancer undergoing cisplatin therapy.

Highlights

Glomerular filtration rate (GFR) assessment is indicated before every administration of cisplatin
It is unclear which method of GFR assessment is optimal for this purpose, with some centers opting for (1) a GFR measurement by urinary Creatinine Clearance, (2) an estimated GFR by a validated formula such as chronic kidney disease (CKD)-EPI, or (3) b oth[9]
The eGFR is based on validated estimation formulae such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and can be assessed with a single blood draw at the day of cisplatin administration[12,13]

Summary

Introduction

Glomerular filtration rate (GFR) assessment is indicated before every administration of cisplatin. A pre-treatment evaluation of kidney function by determining the GFR is mandatory in every patient before every cisplatin administration[8] It is unclear which method of GFR assessment is optimal for this purpose, with some centers opting for (1) a GFR measurement by urinary Creatinine Clearance (uCrCl), (2) an estimated GFR by a validated formula such as CKD-EPI (eGFR), or (3) b oth[9]. The eGFR is based on validated estimation formulae such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and can be assessed with a single blood draw at the day of cisplatin administration[12,13] Despite this conceptual advantage of simplicity, it has not yet been investigated whether a strategy of determining the eGFR only before cisplatin therapy (i.e. omitting uCrCl measurement) is safe for patients by preventing acute kidney injury. In this retrospective study, we investigated the agreement between these two methods in patients with cancer undergoing cisplatin chemotherapy, with the ultimate aim of evaluating whether uCrCl measurement can be safely omitted in pre-cisplatin kidney function assessment

Methods

Results

Conclusion