prospective cross-sectional study estimated glomerular filtration rate from creatinine and cystatin C in adults with solid tumor

Autor(es):Mostrar menos -

Costa e Silva, Veronica T. ^[1] ; Gil Jr, Luiz A. ; Inker, Lesley A. ^[2] ; Caires, Renato A. ^[1] ; Costalonga, Elerson ^[1] ; Coura-Filho, George ^[3] ; Sapienza, Marcelo T. ^[4] ; Castro Jr, Gilberto ; Estevez-Diz, Maria Dp ^[5] ; Zanetta, Dirce Maria T. ^[6] ; Antonangelo, Leila ^[7] ; Marcal, Lia ^[7] ; Tighiouart, Hocine ^[8] ; Miao, Shiyuan ^[2] ; Mathew, Paul ^[9] ; Levey, Andrew S. ^[2] ; Burdmann, Emmanuel A. ^[10]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Inst Canc Estado Sao Paulo, Serv Nefrol, Sao Paulo - Brazil

^[2] Tufts Med Ctr, Div Nephrol, Boston, MA 02111 - USA

^[3] Univ Sao Paulo, Fac Med, Hosp Clin, Inst Canc Estado Sao Paulo, Serv Med Nucl, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Inst Canc Estado Sao Paulo, Radiol & Oncol Dept, Fac Med, Sao Paulo - Brazil

^[5] Castro Jr, Jr., Gilberto, Univ Sao Paulo, Hosp Clin, Fac Med, Inst Canc Estado Sao Paulo, Serv Oncol Clin, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Sch Publ Hlth, Dept Epidemiol, Sao Paulo - Brazil

^[7] Univ Sao Paulo, Div Clin Pathol, Lab Invest Med LIM 03, Med Sch, Sao Paulo - Brazil

^[8] Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Biostat Epidemiol & Res Design Ctr, Boston, MA 02111 - USA

^[9] Tufts Med Ctr, Div Hematol Oncol, Boston, MA 02111 - USA

^[10] Univ Sao Paulo, Serv Nefrol, Lab Invest LIM 12, Fac Med, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Kidney International; v. 101, n. 3, p. 607-614, MAR 2022.
• Citações Web of Science: 0

Resumo

Current guidelines recommend estimating glomerular filtration rate (eGFR) using creatinine (eGFRcr) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation as the first test for GFR evaluation, but the Cockcroft-Gault (CG) equation is still commonly used in oncology practice and clinical trials despite increasing evidence of its inaccuracy compared to measured GFR (mGFR). Guidelines recommend eGFR using cystatin C (eGFRcys) or both markers (eGFRcr-cys) as a confirmatory test, but neither was carefully evaluated in cancer patients. Therefore, we compared performance of the CKD-EPI equations and others to the CG equation in adults with a variety of solid tumors. The mGFR was determined by plasma clearance of Cr-51-EDTA. Bias was defined as the median of the differences between mGFR and eGFR while accuracy was defined as the percentage of estimates that differed by more than 30% from the measured GFR (1-P30). We prospectively recruited 1,200 patients between April 2015 and September 2017 with a mean age and mGFR of 58.8 years and 78.4 ml/min/1.73m 2 , respectively. Bias among eGFRcr equations varied from -8.1 to +6.1 ml/min/1.73 m(2). CG was the least accurate, 1-P30 (95% confidence interval) was 24.9 (22.4- 27.3)%; CKD-EPI had 1-P30 of 19.1 (16.8-21.2)% while eGFRcr-cys had the best performance: bias -2.0 (-2.6 to -1.1) ml/min/1.73m(2) and 1-P30 7.8 (6.3-9.4)%. Thus, the CG equation should not be preferred over CKD-EPI equation, and eGFRcr-cys can be used as a confirmatory test in adults with solid tumors. Hence, a major policy implication would be to adopt general practice guideline-recommended methods for GFR evaluation in oncology practice and clinical trials. (AU)

• Processo FAPESP: 14/19286-4 - Indivíduos com alto risco para desenvolvimento de injúria renal aguda em contextos clínicos relevantes: estudo prospectivo sobre aspectos epidemiológicos, diagnósticos e prognósticos
• Beneficiário: Emmanuel de Almeida Burdmann
• Modalidade de apoio: Auxílio à Pesquisa - Temático