Creatine clearance in adults undergoing chemotherapy

EvidenceSearch4U logoQuestion 

‘There are various different methods to calculate creatinine clearance. We want to know the best method to calculate creatinine clearance in oncology patients. Creatinine clearance is required to work out does of chemotherapy that are subsequently excreted by the kidneys.’

PICO terms

Population / Problem: Adults undergoing chemotherapy Intervention: Creatinine clearance  Comparison: last 10 years Outcome: Which method is the most accurate to work out the creatine clerance in cancer patients?

Top papers identified

Title: Comparative performances of the new chronic kidney disease epidemiology equations incorporating cystatin C for use in cancer patients.
Citation: Asia-Pacific journal of clinical oncology, Jun 2015, vol. 11, no. 2, p. 142-151, 1743-7563 (June 2015)
Author(s): Chew-Harris, Janice S C, Florkowski, Christopher M, George, Peter M, Endre, Zoltan H
Abstract: In cancer patients receiving chemotherapy treatment, accurate assessment of kidney function is required. The aim of our study was to investigate whether the inclusion of cystatin C together with creatinine in prediction equations would improve the prediction of glomerular filtration rate (GFR). Plasma creatinine and cystatin C were analyzed in 155 patients (cancer, n = 80, kidney donors, n = 75) undergoing (99m) Technetium diethylenepentaacetic (Tc-DTPA) GFR clearance. Equations by the CKD-EPI (chronic kidney disease epidemiology) group (creatinine-, creatinine + cystatin C-, cystatin C-based, respectively) and Cockcroft-Gault were compared with Tc-DTPA GFR by difference plots, receiver operator characteristics curve analysis, root mean square error, chi-squared analysis and percentage concordance according to carboplatin dosage. Comparisons between two creatinine methodologies (enzymatic vs Jaffe) were also performed. In the overall group, the combination creatinine and cystatin C equation had 69% of results within 20% of GFR (P20), a sensitivity of 86.3% and a specificity of 73.1% to detect reduced GFR at <90 mL/min/1.73 m(2), and a concordance of 78%. In contrast, the traditional Cockcroft-Gault equation had a P20 of 38.0%, with a large underestimation to predict GFR, thereby accounting for approximately 45% of dosing discordance. No obvious differences were obtained when comparing the performance of equations using the two creatinine methodologies. The inclusion of cystatin C in the CKD-EPI equations improved the prediction of kidney function in the overall population, although probably not sufficiently for it to be favored over radioisotopic GFR for guiding chemotherapy. More research is warranted to further improve estimated GFR equations for these purposes. © 2014 Wiley Publishing Asia Pty Ltd.
Full Text:
Available from EBSCOhost in Asia Pacific Journal of Clinical Oncology

Title: Development of a new equation to estimate creatinine clearance in cancer patients.
Citation: Cancer chemotherapy and pharmacology, Jul 2015, vol. 76, no. 1, p. 117-124, 1432-0843 (July 2015)
Author(s): Chu, Michael P, McCaw, Larissa, Stretch, Cynthia, Butts, Charles, Hanson, John, Kuzma, Michelle, Damaraju, Vijaya L, Baracos, Vickie E, Sawyer, Michael B
Abstract: Determining renal function is important for chemotherapy eligibility and dosing. Measured creatinine clearance (mCrCl) is the gold standard but is cumbersome. Equations estimating CrCl (eCrCl) based on serum creatinine (SCr) produce widely varying estimates. Considering that SCr is derived from skeletal muscle, this study prospectively developed a new eCrCl equation in cancer patients using CT-defined muscle surface area (MSA) and evaluated its utility in a separate, retrospective series. In a prospective, observational cohort study of cancer patients, mCrCl by 24-h urine collection was correlated with CT-determined MSA to create an equation for eCrCl [muscle surface area (cm(2)) × 42/SCr]. eCrCl by Wright, Cockcroft-Gault (CG), CKD-EPI, MDRD, and MSA was compared to mCrCl to determine fit. MSA-eCrCl was used to simulate carboplatin dosing in a retrospective series of advanced non-small cell lung cancer (NSCLC). Prospectively, 22 patients were accrued and evaluable (12 males; median age 69). MSA-eCrCl correlated stronger (r (2) 0.80) than current equations (r (2) 0.47-0.69) with mCrCl. In calculating carboplatin doses for 89 NSCLC patients with MSA and CG-eCrCl, median error of CG-determined carboplatin dose was 5.5 % (range -19.0 to 44.2 %), assuming that MSA was better at estimating CrCl. Forty-two patients (47 %) received doses that varied ≥10 % of what was calculated by MSA. We propose a new formula for eCrCl in patients that appears more accurate than current formulae and may have implications for chemotherapy efficacy and toxicity. Studies to validate this formula are under way.

Title: Are the equations for the creatinine-based estimated glomerular filtration rate applicable to the evaluation of renal function in Japanese children and adult patients receiving chemotherapy?
Citation: Clinical and experimental nephrology, Apr 2015, vol. 19, no. 2, p. 298-308, 1437-7799 (April 2015)
Author(s): Inoue, Nami, Watanabe, Hiroyoshi, Okamura, Kazumi, Kondo, Shuji, Kagami, Shoji
Abstract: Equations for the creatinine-based estimated glomerular filtration rate (eGFR) were recently established for Japanese adults (>18 years old) and children (2-11 years old), respectively, but it is unclear whether eGFR can be as useful as 24-h creatinine clearance (CCr) for assessing renal function in patients receiving chemotherapy. This study examined the degree of concordance between eGFR and CCr and the risk factors leading to the overestimation of renal function by eGFR. A total of 53 data points of 19 children and 56 data points of 16 adults who received chemotherapy were analyzed retrospectively. Body mass index, serum creatinine concentration, 24-h urinary creatinine excretion (UCr), and nephrectomy were considered as risk factors for overestimation by eGFR. In the pediatric part of the study, 7 data points from 3 patients who underwent nephrectomy were included. The eGFR in patients with bilateral kidneys overestimated renal function to a greater degree than in patients with a unilateral kidney. In 45.7 % of pediatric patients with bilateral kidneys and in 19.6 % of adult patients, eGFR overestimated renal function. The risk factor for overestimation was lower UCr in pediatric patients with bilateral kidneys and adult patients. Concordance between eGFR and CCr in pediatric patients with a unilateral kidney should be assessed separately from that in patients with bilateral kidneys. In restricting calculation of eGFR to pediatric patients with bilateral kidneys and adult patients without little muscle mass, eGFR may be useful regardless of whether patients are receiving chemotherapy.
Full Text:
Available from ProQuest in Clinical and Experimental Nephrology
Available from EBSCOhost in Clinical & Experimental Nephrology

Title: Comparison of measured glomerular filtration rates with isotope infusion and with the modification of diet in renal disease equation in cancer patients with raised serum creatinine.
Citation: Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, Mar 2015, vol. 26, no. 2, p. 293-296, 1319-2442 (March 2015)
Author(s): Javaid, Amrah, Jaffri, Saghir Ahmed, Munir, Iqbal, Qazi, Muhammad H, Nawaz, Muhammad Khalid
Abstract: To compare the measured glomerular filtration rate (rGFR) using [99mTc] diethylene triamine pentacetic acid (DTPA) clearance or estimated GFR (eGFR) by the Modification of Diet in Renal Disease (MDRD) equation in cancer patients with raised serum creatinine level, we studied 100 cancer patients; 50 patients with normal serum creatinine (control group) and 50 patients with abnormal serum creatinine (study group). History of patients, including site of cancer, chemotherapy regime and dose of chemotherapy, was recorded. The rGFR and eGFR were increased in the study group as compared with the control group, but the GFR recorded by the MDRD formula or DTPA revealed similar values. It is therefore concluded that the MDRD equation may be recommended for eGFR estimation even with abnormal creatinine, without the need for exposure to radiation.
Full Text:

Title: Evaluation of creatinine-based formulas in dosing adjustment of cancer drugs other than carboplatin.
Citation: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners, Jun 2010, vol. 16, no. 2, p. 113-119, 1477-092X (June 2010)
Author(s): Jennings, Sarah, de Lemos, Mário L, Levin, Adeera, Murray, Nevin
Abstract: Glomerular filtration rate (GFR) is often used to determine initial dosing of renally excreted cancer drugs. GFR can be calculated using the Cockcroft-Gault (CG) or the modified diet in renal diseases (MDRD) study formulas, both of which are based on serum creatinine levels. The MDRD formula is more accurate in noncancer patients, does not require patient weight, and is reported automatically by all laboratories in British Columbia, Canada. We previously showed that the CG and MDRD formulas have similar accuracy for carboplatin dosing in patients with gynecological malignancies. We now examine dosing of all renally excreted cancer drugs in the general cancer population. Since this setting does not include routine measurement of GFR, we report the concordance of estimates of GFR derived from the CG and MDRD formulas. Patient data were collected retrospectively at the BC Cancer Agency. The primary outcome was the proportion of patients who would have received a different initial dose due to difference in the GFR. Each patient’s dose was determined from dose adjustment tables stated in specific treatment protocols. The secondary outcome was concordance of the GFR derived from CG and MDRD, using the method of Bland and Altman. A difference of >30% was assumed to be clinically significant because this difference would usually lead to dose adjustment based on reclassification of renal function. A total of 313 patients were evaluated, with 40% male. The median age was 56 years, weight 67.5 kg, height 166 cm, and serum creatinine 74 micromol/L (0.84 mg/dL). The median GFR derived from the CG and MDRD formulas were 86.8 mL/min (mean 91 mL/min, SD +/- 30 mL/min) and 87.6 mL/min (mean 88 mL/min, SD +/- 26 mL/min), respectively. A total of 8.6% (27/313) of patients would have received a different dose due to difference in the GFR; of these, 67% (18/27) would have received a higher dose. A difference of >30% in GFR was found in 17.9% (56/313) of patients. There is good concordance of the GFR derived from the CG and MDRD formulas for most cancer patients, with less than 10% of patients expected to receive a different initial dose of chemotherapy. The MDRD formula may be a reasonable alternative to the CG formula for dosing of cancer drugs which are renally excreted or nephrotoxic.
Full Text:
Available from ProQuest in Journal of Oncology Pharmacy Practice

Request further Clinical Question Answers.
Posted in Clinical Question Answer