CKD-EPI and Cockcroft-Gault Equations Identify Similar Candidates for Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer

Abstract

Clinical guidelines suggest neoadjuvant cisplatin-based chemotherapy prior to cystectomy in the setting of muscle-invasive bladder cancer (MIBC). A creatinine clearance (CrCl) >60 mL/min is frequently used to characterize cisplatin-eligible patients, and use of the CKD-EPI equation to estimate CrCl has been advocated. From a prospectively maintained institutional database, patients with MIBC who received cystectomy were identified and clinicopathologic information was ascertained. CrCl prior to surgery was computed using three equations: (1) Cockcroft-Gault (CG), (2) CKD-EPI, and (3) MDRD. The primary objective was to determine if the CG and CKD-EPI equations identified a different proportion of patients who were cisplatin-eligible, based on an estimated CrCl of >60 mL/min. Cisplatin-eligibility was also assessed in subsets based on age, CCI score and race. Actuarial rates of neoadjuvant cisplatin-based chemotherapy use were also reported. Of 126 patients, 70% and 71% of patients were found to be cisplatin-eligible by the CKD-EPI and CG equations, respectively (P = 0.9). The MDRD did not result in significantly different characterization of cisplatin-eligibility as compared to the CKD-EPI and CG equations. In the subset of patients age >80, the CKD-EPI equation identified a much smaller proportion of cisplatin-eligible patients (25%) as compared to the CG equation (50%) or the MDRD equation (63%). Only 34 patients (27%) received neoadjuvant cisplatin-based chemotherapy. Of the 92 patients who did not receive neoadjuvant chemotherapy, 64% had a CrCl >60 mL/min by CG. In contrast to previous reports, the CKD-EPI equation does not appear to characterize a broader span of patients as cisplatin-eligible. Older patients (age >80) may less frequently be characterized as cisplatin-eligible by CKD-EPI. The discordance between actual rates of neoadjuvant chemotherapy use and rates of cisplatin eligibility suggest that other factors (e.g., patient and physician preference) may guide clinical decision-making.

Renal Function and All-Cause Mortality Risk Among Cancer Patients

“…In addition, we assessed eGFR using CKD-EPI equation, which has been shown to be more accurately categorized the risk for mortality than did the MDRD formula. 25 - 27 …”

“…Renal function was evaluated by eGFR with the CKD-EPI equation, which has been indicated to be more accurate than the MDRD formula in various populations including Asian, as previously described. 25 – 27 In our study, RI was defined as eGFR < 60 mL/min/1.73 m 2 . The presence of proteinuria was defined as albumin 1+ or greater.…”

Comparison of Equations To Estimate Glomerular Filtration Rate and Their Impact on Frequency of Cisplatin-associated Acute Kidney Injury

“…32 Pal et al retrospectively studied 126 patients with bladder cancer and, contrastingly, found that eGFRCKD-EPI classified a fewer number of patients eligible. 33 We similarly compared the eligible patients in our cohorts and also found a larger number of patients using eGFRCKD-EPI, when compared with CG eCrCl or eGFRMDRD (94% vs 91.0% or 90.2% respectively). However, we believe the number of eligible patients lacks relevance as a stand-alone measure.…”

The Impact of Chronic Kidney Disease in Patients With Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation

“…19 However, several studies have shown comparable performance of these models in patients with cancer. 20,21 Furthermore, recent American Society of Clinical Oncology recommendations endorse the use of either the Cockroft-Gault or Modified Diet in Renal Disease formula for calculating renal function. 7 Several limitations of the present study should be noted.…”