New model for estimating glomerular filtration rate in patients with cancer

Janowitz, T. et al. (2017) New model for estimating glomerular filtration rate in patients with cancer. Journal of Clinical Oncology, (doi: 10.1200/JCO.2017.72.7578) (PMID:28686534)

[img]
Preview
Text
140496.pdf - Published Version
Available under License Creative Commons Attribution.

1MB

Abstract

Purpose: The glomerular filtration rate (GFR) is essential for carboplatin chemotherapy dosing; however, the best method to estimate GFR in patients with cancer is unknown. We identify the most accurate and least biased method. Methods: We obtained data on age, sex, height, weight, serum creatinine concentrations, and results for GFR from chromium-51 (51Cr) EDTA excretion measurements (51Cr-EDTA GFR) from white patients ≥ 18 years of age with histologically confirmed cancer diagnoses at the Cambridge University Hospital NHS Trust, United Kingdom. We developed a new multivariable linear model for GFR using statistical regression analysis. 51Cr-EDTA GFR was compared with the estimated GFR (eGFR) from seven published models and our new model, using the statistics root-mean-squared-error (RMSE) and median residual and on an internal and external validation data set. We performed a comparison of carboplatin dosing accuracy on the basis of an absolute percentage error > 20%. Results: Between August 2006 and January 2013, data from 2,471 patients were obtained. The new model improved the eGFR accuracy (RMSE, 15.00 mL/min; 95% CI, 14.12 to 16.00 mL/min) compared with all published models. Body surface area (BSA)–adjusted chronic kidney disease epidemiology (CKD-EPI) was the most accurate published model for eGFR (RMSE, 16.30 mL/min; 95% CI, 15.34 to 17.38 mL/min) for the internal validation set. Importantly, the new model reduced the fraction of patients with a carboplatin dose absolute percentage error > 20% to 14.17% in contrast to 18.62% for the BSA-adjusted CKD-EPI and 25.51% for the Cockcroft-Gault formula. The results were externally validated. Conclusion: In a large data set from patients with cancer, BSA-adjusted CKD-EPI is the most accurate published model to predict GFR. The new model improves this estimation and may present a new standard of care.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mark, Dr Patrick and White, Dr Jeffery
Authors: Janowitz, T., Williams, E. H., Marshall, A., Ainsworth, N., Thomas, P. B., Sammut, S. J., Shepherd, S., White, J., Mark, P. B., Lynch, A. G., Jodrell, D. I., Tavaré, S., and Earl, H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:Journal of Clinical Oncology
Publisher:American Society of Clinical Oncology
ISSN:0732-183X
ISSN (Online):1527-7755
Published Online:07 July 2017
Copyright Holders:Copyright © 2017 American Society of Clinical Oncology
First Published:First published in Journal of Clinical Oncology 2017
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record