Reliability of estimated glomerular filtration rate in patients treated with platinum containing therapy
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Reliability of estimated glomerular filtration rate in patients treated with platinum containing therapy. / Lauritsen, Jakob; Gundgaard, Maria G; Mortensen, Mette S; Oturai, Peter S; Feldt-Rasmussen, Bo; Daugaard, Gedske.
In: International Journal of Cancer, Vol. 135, No. 7, 2014, p. 1733-1739.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Reliability of estimated glomerular filtration rate in patients treated with platinum containing therapy
AU - Lauritsen, Jakob
AU - Gundgaard, Maria G
AU - Mortensen, Mette S
AU - Oturai, Peter S
AU - Feldt-Rasmussen, Bo
AU - Daugaard, Gedske
N1 - © 2014 UICC.
PY - 2014
Y1 - 2014
N2 - Estimates of glomerular filtration rate (eGFR) are widely used when administering nephrotoxic chemotherapy. No studies performed in oncology patients have shown whether eGFR can safely substitute a measured GFR (mGFR) based on a marker method. We aimed to assess the validity of four major formulas based on PCr (Cockcroft-Gault, MDRD, Wright and CKD-EPI) in comparison to mGFR in an oncology setting. Patients included had disseminated germ cell cancer and received conventional chemotherapy: bleomycin, etoposide and cisplatin. The mGFR of the patients was compared to all estimates with focus on bias (median percentage error), precision (median absolute percentage error) and accuracy (p10 and p30). The precision of carboplatin dosage based on eGFR was calculated. Data on mGFR, eGFR, and PCr were available in 390 patients, with a total of ∼ 1,600 measurements. Median PCr and mGFR synchronically decreased after chemotherapy, yielding high bias and low precision of most estimates. Post-chemotherapy, bias ranged from -0.2% (MDRD after four cycles) to 33.8% (CKD-EPI after five cycles+), precision ranged from 11.6% (MDRD after four cycles) to 33.8% (CKD-EPI after five cycles+) and accuracy (p30) ranged from 37.5% (CKD-EPI after five cycles+) to 86.9% (MDRD after four cycles). Although MDRD appeared acceptable after chemotherapy because of high accuracy, this equation underestimated GFR in all other measurements. Before and years after treatment, Cockcroft-Gault and Wright offered best results. Precision of carboplatin dosage was low. In conclusion, bias, precision and accuracy were unacceptable in all equations due to a synchronous decrease of PCr and mGFR during chemotherapy.
AB - Estimates of glomerular filtration rate (eGFR) are widely used when administering nephrotoxic chemotherapy. No studies performed in oncology patients have shown whether eGFR can safely substitute a measured GFR (mGFR) based on a marker method. We aimed to assess the validity of four major formulas based on PCr (Cockcroft-Gault, MDRD, Wright and CKD-EPI) in comparison to mGFR in an oncology setting. Patients included had disseminated germ cell cancer and received conventional chemotherapy: bleomycin, etoposide and cisplatin. The mGFR of the patients was compared to all estimates with focus on bias (median percentage error), precision (median absolute percentage error) and accuracy (p10 and p30). The precision of carboplatin dosage based on eGFR was calculated. Data on mGFR, eGFR, and PCr were available in 390 patients, with a total of ∼ 1,600 measurements. Median PCr and mGFR synchronically decreased after chemotherapy, yielding high bias and low precision of most estimates. Post-chemotherapy, bias ranged from -0.2% (MDRD after four cycles) to 33.8% (CKD-EPI after five cycles+), precision ranged from 11.6% (MDRD after four cycles) to 33.8% (CKD-EPI after five cycles+) and accuracy (p30) ranged from 37.5% (CKD-EPI after five cycles+) to 86.9% (MDRD after four cycles). Although MDRD appeared acceptable after chemotherapy because of high accuracy, this equation underestimated GFR in all other measurements. Before and years after treatment, Cockcroft-Gault and Wright offered best results. Precision of carboplatin dosage was low. In conclusion, bias, precision and accuracy were unacceptable in all equations due to a synchronous decrease of PCr and mGFR during chemotherapy.
KW - Adult
KW - Antineoplastic Combined Chemotherapy Protocols
KW - Biomarkers, Pharmacological
KW - Bleomycin
KW - Carboplatin
KW - Cisplatin
KW - Creatinine
KW - Etoposide
KW - Follow-Up Studies
KW - Glomerular Filtration Rate
KW - Humans
KW - Kidney Diseases
KW - Male
KW - Neoplasms, Germ Cell and Embryonal
KW - Prognosis
KW - Reproducibility of Results
U2 - 10.1002/ijc.28816
DO - 10.1002/ijc.28816
M3 - Journal article
C2 - 24585507
VL - 135
SP - 1733
EP - 1739
JO - International Journal of Cancer
JF - International Journal of Cancer
SN - 0020-7136
IS - 7
ER -
ID: 137614685