A prospective cross-sectional study estimated glomerular filtration rate from creatinine and cystatin C in adults with solid tumors

Silva, Verônica T. Costa e; Gil-Jr, Luiz A.; Inker, Lesley A.; Caires, Renato Antunes; Costalonga, Elerson Carlos; Coura-Filho, George Barberio; Sapienza, Marcelo Tatit; Castro, Gilberto de; Estevez-Diz, Maria DP.; Zanetta, Dirce Maria Trevisan; Antonângelo, Leila; Marçal, Lia Junqueira; Tighiouart, Hocine; Miao, Shiyuan; Mathew, Paul; Levey, Andrew S.; Burdmann, Emmanuel A.

doi:10.1016/j.kint.2021.12.010

Cited by 33 publications

(43 citation statements)

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“…CG appeared the least accurate (1-P30: 24.9%) and most biased (−8.1%), while the combined creatinine-cystatin C eGFR was the most accurate (1-P30: 7.8%) and least biased (−2.0%). 48 There was no confounding of a specific cancer site with respect to SCr or SCys independent of mGFR. 48 Importantly, all of the included patients were not on active anti-cancer treatment and kidney function assessments in this study should thus be considered baseline values.…”

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confidence: 92%

“…48 There was no confounding of a specific cancer site with respect to SCr or SCys independent of mGFR. 48 Importantly, all of the included patients were not on active anti-cancer treatment and kidney function assessments in this study should thus be considered baseline values. Also, as reported by the authors, many patients had a better clinical performance status, less co-morbidities, less advanced cancer and better nutritional status than the average patient with cancer in their hospital.…”

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confidence: 92%

“…In contrast to these, perhaps somewhat disenchanting findings, a large recent single-center study of 1200 prospectively recruited patients with cancer (new, and in follow-up) with a variety of solid tumors, seems to have validated the place of CKD-EPI formulas in the hierarchy of eGFR equations. 48 In this study, the performance of CG, MDRD, and CKD-EPI (using cystatin C and creatinine alone and in combination) was compared with mGFR determined by 51 Cr-EDTA as reference. Performance was defined as bias (median of difference between eGFR and mGFR) and accuracy (percentage of estimates differing >30% from mGFR, 1-P30).…”

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confidence: 99%

“…Also, as reported by the authors, many patients had a better clinical performance status, less co-morbidities, less advanced cancer and better nutritional status than the average patient with cancer in their hospital. 48 In, contrast many patients with cancer encountered in clinical practice do not exist in a baseline state, have extensive co-morbid disease, are frail and sarcopenic and are on active treatment with chemotherapy or other anti-cancer drugs because of progressive or perhaps refractory neoplastic disease; situations in which possible variations of cystatin C are currently not well explored. It is worth noting that in this study, all traditional eGFR equations that incorporated creatinine (CG, MDRD, and CKD-EPI Cr and CKD-EPI Cr-Cys ) systematically overestimated kidney function, while the cystatin C-based eGFR formula systematically underestimated kidney function providing a more conservative eGFR estimate which could lead to a more patient safe chemotherapy prescription practice yielding lower doses and avoiding side effects or sometimes lethal toxicity, especially in high-risk patients with already established CKD.…”

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confidence: 99%

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Serum cystatin C level can be used to estimate GFR in patients with solid tumors: Moderator Commentary

Vanhoutte

Sprangers

2022

Journal of Onco-Nephrology

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The precise estimation of kidney function in patients with cancer is of great importance as deterioration and decreased kidney function are common and often kidney function-based dose adjustments of chemotherapy and other cancer-related medicines are necessary in these patients. There is an ongoing debate regarding the most suitable technique to determine kidney function based on the availability, accuracy, and validation of available glomerular filtration rate-estimating formulas in patients with cancer. Recent data suggest that cystatin-based formulas are superior to creatinine-based GFR formulas not only in the general population but also in patients with cancer.

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confidence: 92%

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confidence: 92%

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confidence: 99%

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confidence: 99%

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Serum cystatin C level can be used to estimate GFR in patients with solid tumors: Moderator Commentary

Vanhoutte

Sprangers

2022

Journal of Onco-Nephrology

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“…Esta pesquisa faz parte do estudo: "Análise crítica da determinação do ritmo de filtração glomerular em pacientes com câncer", no qual foram estudados prospectivamente 1.200 pacientes matriculados no Instituto do Câncer do Estado de São Paulo (ICESP) de abril de 2015 a setembro de 2017 48 (Anexo A).…”

Section: Desenho Do Estudounclassified

Associação entre cistatina C, fragilidade e desfechos clínicos em idosos com câncer

Gil¹

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grande amigo e conselheiro. Um dos maiores responsáveis pelo desenvolvimento da Geriatria no Brasil e pela formação de centenas de geriatras. Seus ensinamentos transformaram minha forma de cuidar dos idosos. Graças a sua persistência e dedicação colocou a Geriatria em outro patamar e seus frutos são responsáveis pelo aprimoramento contínuo e evolução da Geriatria e Gerontologia.Ao Prof. Dr. Thiago Junqueira Avelino Silva, pela parceria desde a época da preceptoria em Geriatria. Irmão que a vida me deu, de capacidade científica brilhante e que dedicou várias horas de seu tempo à minha formação acadêmica. À Dra. Veronica Torres da Costa e Silva, pela generosidade em me aceitar como parceiro de pesquisa. Por todos os momentos divididos no dia-a-dia da pesquisa, pelo compartilhamento de dúvidas e angústias durante essa jornada e pela contribuição na minha formação científica. Ao Prof. Dr. Emmanuel Burdmann, por confiar e permitir minha participação no projeto de pesquisa.

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Medication-Related Adverse Events and Discordancies in Cystatin C–Based vs Serum Creatinine–Based Estimated Glomerular Filtration Rate in Patients With Cancer

et al. 2023

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ImportanceSerum creatinine–based estimated glomerular filtration rate (eGFRcr) may overestimate the glomerular filtration rate (GFR) in patients with cancer. Cystatin C–based eGFR (eGFRcys) is an alternative marker of GFR.ObjectiveTo determine whether the therapeutic drug levels and adverse events (AEs) associated with renally cleared medications were higher in patients with cancer whose eGFRcys was more than 30% lower than their eGFRcr.Design, Setting, and ParticipantsThis cohort study analyzed adult patients with cancer at 2 major academic cancer centers in Boston, Massachusetts. These patients had their creatinine and cystatin C measured on the same day between May 2010 and January 2022. The date of the first simultaneous eGFRcr and eGFRcys measurement was considered to be the baseline date.ExposureThe primary exposure was eGFR discordance, defined as an eGFRcys that was more than 30% lower than the eGFRcr.Main Outcomes and MeasuresThe primary outcome was risk of the following medication-related AEs within 90 days of the baseline date: (1) supratherapeutic vancomycin trough level greater than 30 μg/mL, (2) trimethoprim-sulfamethoxazole–related hyperkalemia (&gt;5.5 mEq/L), (3) baclofen toxic effect, and (4) supratherapeutic digoxin level (&gt;2.0 ng/mL). For the secondary outcome, a multivariable Cox proportional hazards regression model was used to compare 30-day survival of those with vs without eGFR discordance.ResultsA total of 1869 adult patients with cancer (mean [SD] age, 66 [14] years; 948 males [51%]) had simultaneous eGFRcys and eGFRcr measurement. There were 543 patients (29%) with an eGFRcys that was more than 30% lower than their eGFRcr. Patients with an eGFRcys that was more than 30% lower than their eGFRcr were more likely to experience medication-related AEs compared with patients with concordant eGFRs (defined as eGFRcys within 30% of eGFRcr), including vancomycin levels greater than 30 μg/mL (43 of 179 [24%] vs 7 of 77 [9%]; P = .01), trimethoprim-sulfamethoxazole–related hyperkalemia (29 of 129 [22%] vs 11 of 92 [12%]; P = .07), baclofen toxic effects (5 of 19 [26%] vs 0 of 11; P = .19), and supratherapeutic digoxin levels (7 of 24 [29%] vs 0 of 10; P = .08). The adjusted odds ratio for vancomycin levels more than 30 μg/mL was 2.59 (95% CI, 1.08-7.03; P = .04). Patients with an eGFRcys more than 30% lower than their eGFRcr had an increased 30-day mortality (adjusted hazard ratio, 1.98; 95% CI, 1.26-3.11; P = .003).Conclusions and relevanceResults of this study suggest that among patients with cancer with simultaneous assessment of eGFRcys and eGFRcr, supratherapeutic drug levels and medication-related AEs occurred more commonly in those with an eGFRcys more than 30% lower than their eGFRcr. Future prospective studies are needed to improve and personalize GFR estimation and medication dosing in patients with cancer.

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A prospective cross-sectional study estimated glomerular filtration rate from creatinine and cystatin C in adults with solid tumors

Cited by 33 publications

References 23 publications

Serum cystatin C level can be used to estimate GFR in patients with solid tumors: Moderator Commentary

Serum cystatin C level can be used to estimate GFR in patients with solid tumors: Moderator Commentary

Associação entre cistatina C, fragilidade e desfechos clínicos em idosos com câncer

Medication-Related Adverse Events and Discordancies in Cystatin C–Based vs Serum Creatinine–Based Estimated Glomerular Filtration Rate in Patients With Cancer

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