Kanako Shibata1,2, Yoshinari Yasuda3,4, Ryo Kobayashi5, Yuichi Ando6, Tomoya Shimokata6, Hideki Kamiya7, Mutsuharu Hayashi8, Shoichi Maruyama9, Seiichi Matsuo9, Makoto Nakao10, Teruo Tsuchiya2, Hitomi Teramachi2. 1. Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 2. Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan. 3. Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. yyasuda@med.nagoya-u.ac.jp. 4. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. yyasuda@med.nagoya-u.ac.jp. 5. Department of Pharmacy, Gifu University Hospital, Gifu, Japan. 6. Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan. 7. Division of Diabetes, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi, Japan. 8. Department of Cardiology, Fujita Health University Second Hospital, Nagoya, Japan. 9. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 10. College of Pharmacy, Kinjo Gakuin University, Nagoya, Japan.
Abstract
BACKGROUND: Accurate glomerular filtration rate (GFR) evaluation is significant for drug dosing of carboplatin, anticancer drug excreted mainly from kidney. Serum cystatin-C (sCys-C) is a GFR marker with little affected by body muscle mass volume. And GFR equations based on serum creatinine (eGFRcreat) and sCys-C (eGFRcys) were developed; however, accuracy of eGFRcys has not been elucidated fully among patients with cancer. Therefore, we analyzed the performance of GFR equations among patients with cancer whose GFR values were measured by inulin clearance (Cin). METHODS: Study design was a cross-sectional study. Subjects were 41 patients with cancer whose GFR values were measured by Cin for drug dosing studies of carboplatin or S-1 in Nagoya University Hospital from 2007 to 2010 and 29 non-cancer patients. Correlation with Cin and slope of regression line were evaluated in eGFRcreat and eGFRcys. Single and multiple regression analyses were analyzed to identify associating factors with eGFRcreat/Cin or eGFRcys/Cin. RESULTS: Age, body weight, body mass index (BMI) and sCr were different between cancer patients and non-cancer patients, but sCys-C and Cin were consistent in 2 groups. The slope of the regression line for Cin vs. eGFRcys with zero intercept in cancer patients was 1.10 (95 % CI: 1.02-1.17), which was significantly different from 1.0. In multiple regression analysis revealed that BMI and urinary creatinine excretion were significantly associated with eGFRcreat/Cin, and cancer was only associating factor with eGFRcys/Cin. CONCLUSION: eGFRcys should not be used for evaluation of renal function in patients with cancer because it underestimates GFR.
BACKGROUND: Accurate glomerular filtration rate (GFR) evaluation is significant for drug dosing of carboplatin, anticancer drug excreted mainly from kidney. Serum cystatin-C (sCys-C) is a GFR marker with little affected by body muscle mass volume. And GFR equations based on serum creatinine (eGFRcreat) and sCys-C (eGFRcys) were developed; however, accuracy of eGFRcys has not been elucidated fully among patients with cancer. Therefore, we analyzed the performance of GFR equations among patients with cancer whose GFR values were measured by inulin clearance (Cin). METHODS: Study design was a cross-sectional study. Subjects were 41 patients with cancer whose GFR values were measured by Cin for drug dosing studies of carboplatin or S-1 in Nagoya University Hospital from 2007 to 2010 and 29 non-cancerpatients. Correlation with Cin and slope of regression line were evaluated in eGFRcreat and eGFRcys. Single and multiple regression analyses were analyzed to identify associating factors with eGFRcreat/Cin or eGFRcys/Cin. RESULTS: Age, body weight, body mass index (BMI) and sCr were different between cancerpatients and non-cancerpatients, but sCys-C and Cin were consistent in 2 groups. The slope of the regression line for Cin vs. eGFRcys with zero intercept in cancerpatients was 1.10 (95 % CI: 1.02-1.17), which was significantly different from 1.0. In multiple regression analysis revealed that BMI and urinary creatinine excretion were significantly associated with eGFRcreat/Cin, and cancer was only associating factor with eGFRcys/Cin. CONCLUSION: eGFRcys should not be used for evaluation of renal function in patients with cancer because it underestimates GFR.
Entities:
Keywords:
Cancer; Creatinine; Cystatin C; GFR equation; Japanese
Authors: Gary R Matzke; George R Aronoff; Arthur J Atkinson; William M Bennett; Brian S Decker; Kai-Uwe Eckardt; Thomas Golper; Darren W Grabe; Bertram Kasiske; Frieder Keller; Jan T Kielstein; Ravindra Mehta; Bruce A Mueller; Deborah A Pasko; Franz Schaefer; Domenic A Sica; Lesley A Inker; Jason G Umans; Patrick Murray Journal: Kidney Int Date: 2011-09-14 Impact factor: 10.612
Authors: Lesley A Inker; Christopher H Schmid; Hocine Tighiouart; John H Eckfeldt; Harold I Feldman; Tom Greene; John W Kusek; Jane Manzi; Frederick Van Lente; Yaping Lucy Zhang; Josef Coresh; Andrew S Levey Journal: N Engl J Med Date: 2012-07-05 Impact factor: 91.245
Authors: Janice S C Chew-Harris; Christopher M Florkowski; Peter M George; Zoltan H Endre Journal: Asia Pac J Clin Oncol Date: 2014-12-03 Impact factor: 2.601