Comparison of methods of assessment of renal function in patients with cancer treatedwith cisplatin, carboplatin or methotrexate

Abstract

In patients with cancer treated with cisplatin, carboplatin or methotrexate creatinine clearance calculated using the Cockcroft-Gault formula was compared with measured clearance and with the glomerular filtration rate. In 106 patients the average squared difference for calculated and 24 hour urine creatinine clearance was 0.288, n = 606; and for calculated creatinine clearance and glomerular filtration rate (measured using diethylenetriaminepenta-acetic acid, DTPA), 0.212, n = 34. On 35 of 606 occasions (6%) in 18 patients (17%), the calculated clearance overestimated the 24-hour urine creatinine clearance when it was less than 1 mL/s. In all but one patient, this was explained by factors leading to renal impairment (seven patients) or overestimation of clearance (ascites in two patients) or by an isolated low value of 24-hour urine creatinine clearance (eight patients). Declining renal function with increasing total dose of cisplatin was detected by both calculated and 24-hour urine creatinine clearance in patients with germ cell tumours. Derivation of an equation to predict creatinine clearance showed a linear association with plasma creatinine concentration, patient age, weight and gender. Variability in cancer patients was similar to that in the original Cockcroft-Gault study. Calculation of creatinine clearance can be used in cancer patients to monitor treatment with renally-eliminated chemotherapy agents.

Increased Nephrotoxicity of Combination Taxol and Cisplatin Chemotherapy in Gynecologic Cancers as Compared to Cisplatin Alone

“…The data re viewed included age at the start of the treatment, actual body weight for calculation of creatinine clearance, initial and cumulative cispla tin dose, cumulative dose of taxol, other antineoplastic agents admin istered with cisplatin, the primary site of the cancer, previous treat ments and renal ultrasound at the time of the initial treatment to exclude urinary tract obstruction. Renal function was evaluated before each course, during and 6 months after the period of treatment by the calculated creatinine clearance, using the Cockroft and Gault [4] formula for women which has been used to assess the glomerular filtration rate in cancer patients [5]:…”

Rounding of low serum creatinine levels and consequent impact on accuracy of bedside estimates of renal function in cancer patients

“…These assessments have usually been compared to CrCl, determined by the 24-h urine collection (Chow and Schweizer, 1985;Pesola et al, 1993;Cochran and St John, 1993). There have also been a number of comparisons of the C&G approximation with [Tc 99m ] DTPA, Cr 51 EDTA and other direct measures of GFR (Davila and Gardner, 1987;Robinson et al, 1990;Kesteloot and Joossens, 1996;Millward et al, 1996;Poole et al, 2002). These assessments have almost uniformly concluded that the C&G approximation underestimates GFR for normal and moderately reduced levels of renal function.…”

“…Any such estimate needs to be accurate, convenient and inexpensive, and consequently should be a noninvasive formula-based method, which does not require multiple blood samples or tedious urine collection. Creatinine clearance (CrCl) measurement, through 24-h urine collection, has been used to estimate renal function; however, the reliability of this method is very much dependent on an accurate and complete urine collection, and is therefore frequently unsuitable (Davila and Gardner 1987;McDermott et al, 1987;Chambers et al, 1990;Luke et al, 1990;Robinson et al, 1990;Tsubaki et al, 1993;Millward et al, 1996). Various equations and nomograms have been developed to estimate CrCl from serum creatinine (Scr) concentration (Jelliffe, 1973;Cockcroft and Gault 1976;Martin et al, 1998;Wright et al, 2001).…”

Effects of Renal Function on Pharmacokinetics of Recombinant Human Granulocyte Colony-Stimulating Factor in Lung Cancer Patients

“…The glomerular filtration rate estimated by this formula could be overestimated, since serum creatinine depends on muscle mass, which may be reduced in patients with lung cancer. However, the formula has been used in several studies of cancer patients receiving platinum-based chemotherapy, and it shows a good correlation between CL CR and the glomerular filtration rate (8,19). In comparison, estimation of 24-h CL CR is a time-consuming procedure and is often unreliable due to incomplete 24-h urine collection (6).…”