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Comparative performances of the new chronic kidney disease epidemiology equations incorporating cystatin C for use in cancer patients
Author(s) -
ChewHarris Janice SC,
Florkowski Christopher M,
George Peter M,
Endre Zoltan H
Publication year - 2015
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12312
Subject(s) - cystatin c , renal function , creatinine , kidney disease , urology , medicine , cystatin , concordance , population , carboplatin , endocrinology , chemotherapy , cisplatin , environmental health
Abstract Aim In cancer patients receiving chemotherapy treatment, accurate assessment of kidney function is required. The aim of our study was to investigate whether the inclusion of cystatin C together with creatinine in prediction equations would improve the prediction of glomerular filtration rate ( GFR ). Methods Plasma creatinine and cystatin C were analyzed in 155 patients (cancer, n = 80, kidney donors, n = 75) undergoing 99m Technetium diethylenepentaacetic (Tc‐DTPA) GFR clearance. Equations by the CKD‐EPI (chronic kidney disease epidemiology) group (creatinine‐, creatinine + cystatin C ‐, cystatin C ‐based, respectively) and C ockcroft– G ault were compared with Tc‐DTPA GFR by difference plots, receiver operator characteristics curve analysis, root mean square error, chi‐squared analysis and percentage concordance according to carboplatin dosage. Comparisons between two creatinine methodologies (enzymatic vs J affe) were also performed. Results In the overall group, the combination creatinine and cystatin C equation had 69% of results within 20% of GFR ( P 20), a sensitivity of 86.3% and a specificity of 73.1% to detect reduced GFR at <90 mL/min/1.73 m 2 , and a concordance of 78%. In contrast, the traditional C ockcroft– G ault equation had a P 20 of 38.0%, with a large underestimation to predict GFR , thereby accounting for approximately 45% of dosing discordance. No obvious differences were obtained when comparing the performance of equations using the two creatinine methodologies. Conclusion The inclusion of cystatin C in the CKD‐EPI equations improved the prediction of kidney function in the overall population, although probably not sufficiently for it to be favored over radioisotopic GFR for guiding chemotherapy. More research is warranted to further improve estimated GFR equations for these purposes.