Overestimation of carboplatin doses is avoided by radionuclide GFR measurement

Abstract

Background:Glomerular filtration rate (GFR) is used in the calculation of carboplatin dose. Glomerular filtration rate is measured using a radioisotope method (radionuclide GFR (rGFR)), however, estimation equations are available (estimated GFR (eGFR)). Our aim was to assess the accuracy of three eGFR equations and the subsequent carboplatin dose in an oncology population.Patients and methods:Patients referred for an rGFR over a 3-year period were selected; eGFR was calculated using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockcroft-Gault (CG) equations. Carboplatin doses were calculated for those patients who had received carboplatin chemotherapy. Bias, precision and accuracy were examined.Results:Two hundred and eighty-eight studies met the inclusion/exclusion criteria. Paired t-tests showed significant differences for all three equations between rGFR and eGFR with biases of 12.3 (MDRD), 13.6 (CKD-EPI) and 7.7 ml min−1 per 1.73 m2 (CG). An overestimation in carboplatin dose was seen in 81%, 87% and 66% of studies using the MDRD, CKD-EPI and CG equations, respectively.Conclusion:The MDRD and CKD-EPI equations performed poorly compared with the reference standard rGFR; the CG equation showed smaller bias and higher accuracy in our oncology population. On the basis of our results we recommend that the rGFR should be used for accurate carboplatin chemotherapy dosing and where unavailable the use of the CG equation is preferred.

Performance of formulae based estimates of glomerular filtration rate for carboplatin dosing in stage 1 seminoma

“…Craig et al found all estimating equations (MDRD, CKD-EPI, CG) to be associated with carboplatin overdosing (in 60-80% of cases) in a wide spectrum of oncology patients with the majority of subjects having gynaecological, lung, lymphoma and upper GI cancers (24). This study highlights the difficulties in using estimating equations to calculate carboplatin doses in oncology patients.…”

68Ga-EDTA PET/CT Imaging and Plasma Clearance for Glomerular Filtration Rate Quantification: Comparison to Conventional 51Cr-EDTA

“…Although useful for identifying patients with renal impairment, it is too inaccurate across the full range of GFR for purposes such as determining chemotherapy dosing (1)(2)(3). More recently, the Modification of Diet in Renal Disease (MDRD) (4) and the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (5) formulae have been shown to provide more accurate estimations.…”

Adaptation posologique des médicaments et fonction rénale : quel(s) estimateur(s) faut-il choisir ?

“…Toutes ces é tudes sont cependant des simulations et nous en ré sumons les principales dans le Tableau 2 [49,50,52,[54][55][56][57][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84]. À la vue de ce tableau, le moins que l'on puisse dire est que les é tudes ne sont pas toujours d'une qualité mé thodologique irré prochable (notamment en termes de « cré atinine »), que les mé thodologies et les simulations sont parfois assez diffé rentes, et enfin que les ré sultats de ces publications, en termes du choix de la formule, sont trè s contradictoires.…”

“…C'est le cas, par exemple, dans le contexte d'une chimiothé rapie né phrotoxique, qui plus est si la fenêtre thé rapeutique est é troite et/ou si le patient concerné a un gabarit hors norme. Ainsi, avant une chimiothé rapie à base de dé rivé s du platine, certains auteurs recommandent une mesure du DFG afin d'adapter au mieux la dose à administrer (formule de Calvert et d'Eckardt) [66,79,81,82,108]. La place du DFGm dans la problé matique de l'adaptation posologique est en fait centrale et devrait être considé ré e dè s les premiè res phases de dé veloppement des mé dicaments.…”