Annals of Oncology Advance Access published online on March 9, 2007
Annals of Oncology, doi:10.1093/annonc/mdm055
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© 2007 European Society for Medical Oncology
Monitoring of renal function in cancer patients: an ongoing challenge for clinical practice
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.
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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