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Annals of Oncology Advance Access originally published online on March 9, 2007
Annals of Oncology 2007 18(5):950-958; doi:10.1093/annonc/mdm055
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© 2007 European Society for Medical Oncology

supportive care

Monitoring of renal function in cancer patients: an ongoing challenge for clinical practice

M Kleber1, M Cybulla3, K Bauchmüller1, G Ihorst2, B Koch4 and M Engelhardt1,*

1 Department of Hematology and Oncology, Medical Center
2 Department of Statistics and Biometry/Institute of Medical Biometry and Medical Informatics
3 Department of Nephrology, Medical Center
4 Central Laboratory, University of Freiburg, Freiburg, Germany

* Correspondence to: Prof Dr M. Engelhardt, Hematology and Oncology Department, Freiburg University Medical Center, Hugstetterstrasse 55, D-79106 Freiburg, Germany. Tel: +49 761 270 3256; Fax: +49 761 270 3318; E-mail: monika.engelhardt{at}uniklinik-freiburg.de

Background: Renal impairment (RI) has been shown to be one major risk factor in a number of diseases and is associated with a dismal clinical outcome. However, the influence of milder degrees of renal disease is less well defined, particularly not in patients with malignant diseases.

Patients and methods: We analyzed 167 patients with solid tumors and hematological malignancies. Besides disease-specific parameters, serum creatinine, cystatin C and the estimated glomerular filtration rate (eGFR) [‘modification of diet in renal disease’ equation (MDRD)/Cockcroft-Gault (CG)] were determined. Patients were compared within eGFR, creatinine and cystatin C groups.

Results: The median MDRD, CG, creatinine and cystatin C levels of all patients were 88 ml/min/1.73 m2, 89 ml/min, 1 mg/dl and 0.9 mg/l, respectively. Patients with chronic kidney disease stage 2 still showed normal creatinine and cystatin levels of 1 mg/dl and 1.1 mg/l, respectively, although mild RI was frequent. Those cancer patients with decreased eGFR (MDRD) (<60 ml/min/1.73 m2) had increased odds ratios (ORs) to have more concurrent diagnoses [OR 3.4; 95% confidence interval (CI) 1.5–8.1], a body mass index >24 kg/m2 (OR 2.1; 95% CI 1.0–4.5) and an elevated (>245 pg/ml) pro-brain natriuretic peptide level (proBNP) (OR 9.2; 95% CI 3.0–28.3).

Conclusions: These observations suggest that grouping cancer patients according to renal function, especially eGFR, may be one way to determine specific risk groups.

Key words: cancer patients, comorbidities, renal impairment

Received for publication April 13, 2006. Revision received September 27, 2006. Revision received November 30, 2006. Accepted for publication January 15, 2007.


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