title: Carboplatin dose calculation in lung cancer patients with low serum creatinine concentrations using CKD-EPI and Cockcroft-Gault with different weight descriptors.
abstract: OBJECTIVE
  Carboplatin dosing using the Calvert and Cockcroft-Gault formulae in patients with low serum creatinine levels is discussed controversially. We conducted a retrospective analysis applying the CKD-EPI formula and the alternate size descriptors adjusted body weight and predicted normal weight in the Cockcroft-Gault equation for calculating the carboplatin dose.
  
  
  METHODS
  Data were collected retrospectively from 128 lung cancer patients with serum creatinine <0.8 mg/dL (71 μmol/L) who had received chemotherapy that was mostly platinum-based. Serum creatinine concentration for renal function estimation and measured creatinine clearance (24-h urine collection) were available on the same day from these patients. Actual doses were calculated based on the Cockcroft-Gault formula with total body weight. For the study purpose doses were recalculated using Cockcroft-Gault with adjusted body weight and predicted normal weight and CKD-EPI. Subgroup analyses were performed for gender and body mass index.
  
  
  RESULTS
  All alternate dose calculations were not inferior to the calculation based on Cockcroft-Gault using total body weight. In overweight and obese patients they were superior in reducing mean overdose from 24% to roughly 15% (predicted normal weight, CKD-EPI) and 10% (adjusted body weight) and from 25% to 9%, 8% and 4%, respectively. Best performed the combination of Cockcroft-Gault with adjusted body weight.
  
  
  CONCLUSIONS
  The results show that application of the alternate size descriptor adjusted body weight in the Cockcroft-Gault equation can improve dosing accuracy especially in overweight and obese patients with low serum creatinine levels.
authors.affiliation: Pharmacy Department, Thoraxklinik Heidelberg, University of Heidelberg, Amalienstrasse 5, 69126 Heidelberg, Germany. dieter.kaag@thoraxklinik-heidelberg.de
authors.forename: Dieter
authors.initials: D
authors.lastname: Kaag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D016190:Carboplatin / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood*; D054796:Drug Dosage Calculations; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D003404:Creatinine; D016190:Carboplatin