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


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.
Kleber
M
M
Department of Hematology and Oncology, Medical Center, University of Freiburg, Freiburg, Germany.
Cybulla
M
M
Bauchmüller
K
K
Ihorst
G
G
Koch
B
B
Engelhardt
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D019337:Hematologic Neoplasms / Q000473:pathology*; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000503:physiopathology* / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009369:Neoplasms / Q000145:classification / Q000473:pathology*; D011498:Protein Precursors / Q000097:blood
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D003404:Creatinine