Abstract
The frequent need to obtain an estimate of renal function in cancer patients, not least for targeting carboplatin dose, has led to a number of approaches to estimate glomerular filtration rate (GFR). This study aimed to develop a simple and reliable method to estimate GFR using readily-available patient characteristics. Data from 62 patients with estimates of 51Cr-EDTA clearance were analysed to determine the most appropriate formula relating this method of measuring GFR to patient characteristics. The population pharmacokinetics of 51Cr-EDTA were analysed using NONMEM to evaluate the influence of each covariate. The formulae derived were then validated using a further 38 patients and compared with those obtained using existing formulae 51Cr-EDTA clearance (GFR) was positively related to Dubois surface area, negatively related to age, and inversely related to serum creatinine (SCr). Females had lower 51Cr-EDTA clearance than males. The enzymatic method of SCr assay gave more reliable results than the Jaffe colorimetric method. A measure of creatine kinase significantly improved the estimation of GFR. The new formula produced estimates of GFR which were less biased (Mean Prediction Error = –3%) and more precise (Mean Absolute Prediction Error = 12%) than Cockcroft and Gault (–8% and 16%) or Jelliffe (–15% and 19%) estimates. The formulae developed here can be used to provide reliable estimates of GFR, particularly in regard to targeted dosing of carboplatin. © 2001 Cancer Research Campaign
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Ando Y, Saka HMA, Sakai S and Shimokata K (1997) Adjustment of creatinine clearance improves accuracy of Calvert’s formula for carboplatin dosing. Br J Cancer 76: 1067–1071
Boeckmann A, Beal SL and Sheiner LB (1997) Technical report of the Division of Clinical Pharmacology. NONMEM users manual V5,
Calvert AH (1997) A review of the pharmacokinetics and pharmacodynamics of combination carboplatin/paclitaxel. Semin Oncol 24: S85–S90
Calvert AH Newell DR, Gumbrell LA, O’Reilly S, Burnell M, Boxall FE, Siddik ZH, Judson IR, Gore ME and Wiltshaw E (1989) Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 7: 1748–1756
Chantler C, Garnett ES, Parsons V and Veall N (1969) Glomerular filtration rate measurement in man by the single injection method using51CrEDTA. Clinical Science 37: 169–190
Chatelut E, Canal P, Brunner V, Chevreau C, Pujol A, Boneu A, Roche H, Ilouin G and Bugat R (1995) Prediction of carboplatin clearance from standard morphological and biological patient characteristics. J Natl Cancer Inst 87: 573–580
Childs W, Nicholls J and Horwich A (1992) The optimisation of carboplatin dose in carboplatin, etoposide and bleomycin combination chemotherapy for good prognosis metastatic nonseminomatous germ cell tumours of the testis. Ann Oncol 3: 291–296
Cockcroft D and Gault M (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41
Dubois D and Dubois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Archives of Internal Medicine 17: 863–871
Efroymson MA (1962). Mathematical Methods for Digital Computers, Ralston A, Wilf HS (eds), pp Wiley: New York
Egorin MJ, van Echo DA, Tipping SJ, Olman EA, Whitacre MY, Thompson BW and Aisner J (1984) Pharmacokinetics and dosage reduction of cis-diammine (1, 1-cyclobutanedicarboxylato)platinum in patients with impaired renal function. Cancer Res 44: 5432–5438
Fukuda M, Oka M, Soda H, Terashi K, Kawabata S, Nakatomi K, Takatani H, Tsurutani J, Tsukamoto K, Noguchi Y, Fukuda M, Kinoshita A and Kohno S (1999) Phase I study of irinotecan combined with carboplatin in previously untreated solid cancers. Clinical Cancer Research 5: 3963–3969
Gehan EA and George SL (1970) Estimation of human body surface area from height and weight. Cancer Chemother Rep 54: 225–235
Gietema JA, Veldhuis GJ, Guchelaar HJ, Willemse PHB, Uges DRA, Cats A, Boonstra H, van der Graaf WTA, Sleijfer DT, de Vries EGE and Mulder NH (1995) Phase II and pharmacokinetic study of lobaplatin in patients with relapsed ovarian cancer. Br J Cancer 71: 1302–1307
Hartman AE (1985) Accuracy of creatinine results reported by participants in the CAP Chemistry Survey Program. Archives of Pathology and Laboratory Medicine 109: 1068–1071
Huitema ADR, Mathot RAA, Tibben MM, Schellens JHM, Rodenhuis S and Beijnen JH (2000) Validation of techniques for the prediction of carboplatin exposure: Application of Bayesian methods. Clinical Pharmacology and Therapeutics 67: 621–630
Jelliffe R (1973) Creatinine clearance: bedside estimate. Ann Intern Med 79: 604–605
Jelliffe R, Iglesias T, Hurst A, Foo K and Rodriguez J (1991) Individualising gentamicin dosage regimens: A comparative review of selected models, data fitting methods and monitoring strategies. Clin Pharmacokin 21: 461–478
Jodrell DI, Egorin MJ, Canetta RM, Langenberg P, Goldbloom EP, Burroughs JN, Goodlow JL, Tan S and Wiltshaw E (1992) Relationships between carboplatin exposure and tumor response and toxicity in patients with ovarian cancer. J Clin Oncol 10: 520–528
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N and Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Ann Intern Med 130: 461–470
Martin L, Chatelut E, Boneu A, Rostaing L, Roussilhes C and Caselles O (1998) Improvement of the Cockcroft and Gault equation for predicting glomerular filtration in cancer patients. Bulletin du Cancer 85: 631–636
Millward MJ, Webster LK, Toner GC, Bishop JF, Rischin D, Stokes KH, Johnston VK and Hicks R (1996) Carboplatin dosing based on measurement of renal function – experience at the Peter MacCallum Cancer Institute. Australian and New Zealand Journal of Medicine 26: 372–379
Newell DR, Pearson ADJ, Balmanno K, Price L, Wyllie RA, Kier M, Calvert AH, Lewis IJ, Pinkerton CR and Stevens MCG (1993) Carboplatin pharmacokinetics in children: the development of a pediatric dosing formula. J Clin Oncol 11: 2314–2323
Okamoto H, Nagatomo A, Kunitoh H, Kunikane and Watanabe K (1998) Prediction of carboplatin clearance: comparison of the performance of three formulae. Cancer Chemother Pharmacol 42: 307–312
O’Reilly S, Rowinsky EK, Slichenmeyer W, Donehower RC, Forastiere AA, Ettinger DS, Chen TL, Sartorius S and Grochow LB (1996) Phase I and pharmacologic study of topotecan in patients with impaired renal function. J Clin Oncol 14: 3062–3073
Peng B, Boddy A, Cole M, Pearson A, Chatelut E, Rubie H and Newell D (1995) A comparison of methods used in the estimation of carboplatin pharmacokinetics in paediatric cancer patients. Eur J Cancer 31a: 1804–1810
Perrone RD, Steinman TI, Beck GJ, Skibinski CI, Royal HD, Lawlor M and Hunsicker LG (1990) Utility of radioisotopic filtration markers in chronic renal insufficiency: Simultaneous comparison of125I-iothalamate, 169Yb-DTPA, 99 mTc-DTPA and inulin. Am J Kid Dis 16: 224–235
Perrone RD, Madias NE and Levey AS (1992) Serum creatinine as an index of renal function: New insights into old concepts. Clin Chem 38: 1933–1953
Pflüger, K-H, Hahn M, Holz J-B, Schmidt L, Köhl P, Fritsch H-W, Jungclas H and Havemann K (1993) Pharmacokinetics of etoposide: correlation of pharmacokinetic parameters with clinical conditions. Cancer Chemother Pharmacol 31: 350–356
Reece PA, Stafford I, Russell J, Khan M and Gill PG (1987) Creatinine clearance as a predictor of ultrafilterable platinum disposition in cancer patients treated with cisplatin: relationship between peak ultrafilterable platinum plasma levels and nephrotoxicity. J Clin Oncol 5: 304–309
Salazar DE and Corcoran GB (1988) Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med 84: 1053–1060
Stoller R, Jacobs S, Drake J, Lutz R and Chabner B (1975) Pharmacokinetics of high-dose methotrexate (NSC-740). Cancer Chemother Rep 6: 19–24
Van Warmerdam LJC, Rodenhuis S, ten Bokkel Huinink WW, Maes RAA and Beijnen JH (1996) Evaluation of formulas using the serum creatinine level to calculate the optimal dose of carboplatin. Cancer Chemother Pharmacol 37: 266–270
Wright JG, Calvert AH, Highley MS, Roberts JT, MacGill A, Fenwick J and Boddy AV (1999) Accurate prediction of renal function for carboplatin dosing. Proc Amer Assoc Cancer Res Philadelphia, PA 40: Abs 2542
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Wright, J., Boddy, A., Highley, M. et al. Estimation of glomerular filtration rate in cancer patients. Br J Cancer 84, 452–459 (2001). https://doi.org/10.1054/bjoc.2000.1643
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1054/bjoc.2000.1643
Keywords
This article is cited by
-
Glomerular filtration rate measurement during platinum treatment for urothelial carcinoma: optimal methods for clinical practice
International Journal of Clinical Oncology (2024)
-
Population pharmacokinetics of cisplatin in small cell lung cancer patients guided with informative priors
Cancer Chemotherapy and Pharmacology (2022)
-
A novel nomogram to predict the reliability of estimated glomerular filtration rate formulae in oncology patients
BMC Cancer (2020)
-
Pharmacokinetics of high-dose carboplatin in children undergoing high-dose chemotherapy and autologous stem cell transplantation with BSA-based dosing
Bone Marrow Transplantation (2020)
-
Carboplatin dose capping affects pCR rate in HER2-positive breast cancer patients treated with neoadjuvant Docetaxel, Carboplatin, Trastuzumab, Pertuzumab (TCHP)
Breast Cancer Research and Treatment (2020)