Cancer and renal insufficiency results of the BIRMA study.
BACKGROUND
half of anticancer drugs are predominantly excreted in urine. Dosage adjustment in renal insufficiency (RI) is, therefore, a crucial issue. Moreover, patients with abnormal renal function are at high risk for drug-induced nephrotoxicity. The Belgian Renal Insufficiency and Anticancer Medications (BIRMA) study investigated the prevalence of RI in cancer patients, and the profile/dosing of anticancer drugs prescribed.


METHODS
primary end point: to estimate the prevalence of abnormal glomerular filtration rate (GFR; estimated with the abbreviated Modification of Diet in Renal Disease formula) and RI in cancer patient. Secondary end point: to describe the profile of anticancer drugs prescribed (dose reduction/nephrotoxicity). Data were collected for patients presenting at one of the seven Belgian BIRMA centres in March 2006.


RESULTS
a total of 1218 patients were included. The prevalence of elevated SCR (> or =1.2 mg per 100 ml) was 14.9%, but 64.0% had a GFR<90 ml min(-1) per 1.73 m(2). In all, 78.6% of treated patients (n=1087) were receiving at least one drug needing dosage adjustment and 78.1% received at least one nephrotoxic drug. In all, 56.5% of RI patients receiving chemotherapy requiring dose reduction in case of RI did not receive dose adjustment.


CONCLUSIONS
the RI is highly frequent in cancer patients. In all, 80% of the patients receive potentially nephrotoxic drugs and/or for which dosage must be adjusted in RI. Oncologists should check the appropriate dose of chemotherapeutic drugs in relation to renal function before prescribing.
Service ICAR, Department of Nephrology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, Paris 75013, France. nicolas.janus@psl.aphp.fr
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N
Janus
V
V
Launay-Vacher
E
E
Byloos
J-P
JP
Machiels
L
L
Duck
J
J
Kerger
W
W
Wynendaele
J-L
JL
Canon
W
W
Lybaert
J
J
Nortier
G
G
Deray
H
H
Wildiers
D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000556:secondary; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D051437:Renal Insufficiency / Q000139:chemically induced / Q000503:physiopathology*
D000970:Antineoplastic Agents; D003404:Creatinine