Estimation of renal function in lung cancer patients

Trobec, Katja; Knez, Lea; Meško Brguljan, Pika; Cufer, Tanja; Lainščak, Mitja

doi:10.1016/j.lungcan.2011.11.016

« Previous Next »Lung Cancer
Volume 76, Issue 3 , Pages 397-402, June 2012

Estimation of renal function in lung cancer patients

Katja Trobec
- Pharmacy Department, University Clinic Golnik, Golnik 36, 4204 Golnik, Slovenia
Lea Knez
- Pharmacy Department, University Clinic Golnik, Golnik 36, 4204 Golnik, Slovenia
Pika Meško Brguljan
- Laboratory for Clinical Biochemistry and Haematology, University Clinic Golnik, Golnik 36, 4204 Golnik, Slovenia
Tanja Cufer
- Division of Oncology, University Clinic Golnik, Golnik 36, 4204 Golnik, Slovenia
Mitja Lainščak
- Division of Cardiology, University Clinic Golnik, Golnik 36, 4204 Golnik, Slovenia
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Corresponding author at: Division of Cardiology, University Clinic Golnik, Golnik 36, 4204 Golnik, Slovenia. Tel.: +386 4 25 69 141; fax: +386 4 25 69 117.

Received 3 August 2011; received in revised form 28 October 2011; accepted 12 November 2011. published online 19 December 2011.

Abstract

Introduction

In lung cancer patients treated with chemotherapy, renal function is an important parameter to be monitored. Since measurement of renal function with either isotope or creatinine clearance is time consuming and expensive, we evaluated which of the following equations: Cockcroft–Gault (CG), Wright, modification of diet in renal disease equation (MDRD), MDRD adjusted for body surface area (BSA) and chronic kidney disease epidemiology collaboration (CKD-EPI) best resembles endogenous creatinine clearance (ECC) and could therefore replace its measurement in clinical practice.

Methods

218 lung cancer patients, who had their 24-h creatinine secretion in urine measured prior to the start of any chemotherapy, were included. Estimation of renal function was calculated and compared to ECC.

Results

There were no major differences in the performance of the tested equations. Mean percentage error of more than 20% and general underestimation was common to all equations. Wright equation performed best although it describes only 43% of ECC variability. Mean measured ECC was 94mL/min (95% confidence interval [CI]: 90–98mL/min) and 90mL/min for Wright equation (95% CI: 87–93mL/min) (Supp. Fig. 3). MDRD and CKD-EPI equation performed poorest since they do not include any body size descriptor. Large deviations of differences were observed, with a median standard deviation of more than 20% and deviations from ECC exceeding 100%. Wright equation performed best, whereas, despite their leading role in the detection of renal diseases, the MDRD and CKD-EPI equation performed poorest since they do not include any body size descriptor. In the range of ECC<50mL/(min×1.73m²), the CG equation most often detected a contraindication for cisplatin use. Differences between ECC and calculated values correlated with patients’ weight, BSA and body mass index when these were not included in the equation itself.

Conclusions

In evaluating the renal function of lung cancer patients, equations adjusted for body size descriptors should be preferred. Estimated renal function should be interpreted against the characteristics of patient's body size and special attention is needed when these are reaching the extremes.

Keywords: Glomerular filtration rate, Lung cancer, Cockcroft–Gault equation, Wright equation, MDRD equation, CKD-EPI equation