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International Journal of Clinical Oncology

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Open Access 05-01-2024 | Urothelial Cancer | Original Article

Glomerular filtration rate measurement during platinum treatment for urothelial carcinoma: optimal methods for clinical practice

Authors: Dag Rune Stormoen, Ulla Nordström Joensen, Gedske Daugaard, Peter Oturai, Emil Hyllested, Jakob Lauritsen, Helle Pappot

Published in: International Journal of Clinical Oncology | Issue 3/2024

Abstract

Background

We assessed the accuracy of four estimated glomerular filtration rate (eGFR) methods: MDRD, Cockcroft–Gault, CKD-EPI, and Wright.

Method

The four methods were compared to measure GFR (mGFR) in patients with urothelial urinary tract cancer (T2-T4bNxMx) receiving platinum-based chemotherapy at Rigshospitalet, Copenhagen, from January 2019 to December 2021. Using standardized assays, creatinine values were measured, and mGFR was determined using Technetium-99 m diethylenetriaminepentaacetic acid (Tc-99 m-DTPA) or Cr-51-ethylenediaminetetraacetic acid (Cr-51-EDTA) plasma clearance. Patients (n = 146) with both mGFR and corresponding creatinine values available were included (n = 345 measurements).

Results

The CKD-EPI method consistently demonstrated superior accuracy, with the lowest Total Deviation Index of 21.8% at baseline and 22.9% for all measurements compared to Wright (23.4% /24.1%), MDRD (26.2%/25.5%), and Cockcroft–Gault (25.x%/25.1%). Bland Altman Limits of agreement (LOA) ranged from − 32 ml/min (Cockcroft–Gault) to + 33 ml/min (MDRD), with CKD-EPI showing the narrowest LOA (− 27 ml/min to + 24 ml/min and lowest bias (0.3 ml/min). Establishing an eGFR threshold at 85 ml/min—considering both the lower limit of agreement (LOA) and the minimum cisplatin limit at 60 ml/min—allows for the safe omission of mGFR in 30% of patients in this cohort.

Conclusion

CKD-EPI equation emerged as the most suitable for estimating kidney function in this patient group although not meeting benchmark criteria. We recommend its use for initial assessment and ongoing monitoring, and suggest mGFR for patients with a CKD-EPI estimated GFR below 85 ml/min. This approach could reduce costs and decrease laboratory time for 30% of our UC patients.

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Title: Glomerular filtration rate measurement during platinum treatment for urothelial carcinoma: optimal methods for clinical practice
Authors: Dag Rune Stormoen
Ulla Nordström Joensen
Gedske Daugaard
Peter Oturai
Emil Hyllested
Jakob Lauritsen
Helle Pappot
Publication date: 05-01-2024
Publisher: Springer Nature Singapore
Keywords: Urothelial Cancer
Urothelial Cancer
Published in: International Journal of Clinical Oncology / Issue 3/2024
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-023-02454-3

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