Impact of the chronic kidney disease epidemiology collaboration (CKD-EPI) equation for estimating renal function on eligibility for cisplatin-based chemotherapy in patients with bladder cancer.

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e15139 Background: Cisplatin-based chemotherapy is standard treatment for patients with advanced bladder cancer. However, a large proportion of patients with advanced bladder cancer are ineligible for cisplatin-based chemotherapy due to impaired renal function. Though the Cockroft-Gault (CG) equation is generally utilized to estimate renal function and determine “cisplatin eligibility,” the CKD-EPI equation (Levey, Ann Intern Med, 2009) has recently emerged as the preferred method for calculating glomerular filtration rate (GFR). We sought to determine the impact of methods of estimating renal function on “cisplatin eligibility.” Methods: The Mount Sinai Data Warehouse was utilized to identify all patients diagnosed with bladder cancer at our institution between 1/1/2000 and 1/1/2011. Variables extracted for analysis included gender, race, age, weight, and serum creatinine. Patients with missing data, age <18 or >110, or a creatinine of < 0.6 or > 7 mg/dl were excluded. For each patient, CrCl was estimated using the GC equation and GFR was estimated using the Modification of Diet in Renal Disease (MDRD) and CKD-EPI equations. Patients were considered cisplatin-ineligible if CrCl or GFR was < 60. Results: 567 patients with bladder cancer were identified; 54 were excluded for creatinine range, 82 for duplicate entries, 82 for missing data, and 1 for age limit. 409 patients, with a median age of 78 (range, 37-103) were included in the final analysis. The results are detailed in the table. Conclusions: The CG formula substantially overestimates the proportion of cisplatin-ineligible patients based on a standard renal function threshold. Use of the more precise CKD-EPI equation should be considered when evaluating suitability for cisplatin in patients with bladder cancer. Formula Median CrCl or GFR (range) Cisplatin-ineligible CG 54 (4-215) 232/409 (57%) MDRD 64 (6-154) 180/409 (44%) CKD-EPI 64 (6-128) 179/409 (44%)