Estimated glomerular filtration rate is an easy predictor of venous thromboembolism in cancer patients undergoing platinum-based chemotherapy.
Reduced estimated glomerular filtration rate (eGFR) has been associated with increased venous thromboembolism (VTE) risk in the general population. VTE incidence significantly increases in cancer patients, especially those undergoing chemotherapy. Despite the evidence that a substantial number of cancer patients have unrecognized renal impairment, as indicated by reduced eGFR in the presence of serum creatinine levels within the reference value, chemotherapy dosage is routinely adjusted for serum creatinine values. Among chemotherapies, platinum-based regimens are associated with the highest rates of VTE. A cohort study was designed to assess the value of pretreatment eGFR in the risk prediction of a first VTE episode in cancer outpatients without previous history of VTE who were scheduled for platinum-based chemotherapy. Methods. Serum creatinine and eGFR were evaluated before the start of standard platinum-based chemotherapy in a cohort of 322 consecutive patients with primary or relapsing/recurrent solid cancers, representative of a general practice population. Results. Patients who experienced a first VTE episode in the course of chemotherapy had lower mean eGFR values compared with patients who remained VTE free. Multivariate Cox analysis demonstrated that eGFR had an independent value for risk prediction of a first VTE episode during treatment, with a 3.15 hazard ratio. Indeed, 14% of patients with reduced eGFR had VTE over 1-year follow-up compared with 6% of patients with normal eGFR values. Conclusion. The results suggest that reductions in eGFR, even in the presence of normal serum creatinine, are associated with an increased VTE risk in cancer outpatients undergoing platinum-based chemotherapy regimens. Determining eGFR before chemotherapy could represent a simple predictor of VTE, at no additional cost to health care systems.
Biomarker Discovery and Advanced Technologies (BioDAT) Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana-Research Center, Rome, Italy; Department of System Medicine, Medical Oncology, Tor Vergata Clinical Center, University of Rome "Tor Vergata," Rome, Italy; Section of Medical Oncology, Department of Surgical and Oncology Sciences, University of Palermo, Palermo, Italy; Internal Medicine and Center of Excellence on Aging, "G. d'Annunzio" University Foundation, Chieti, Italy.
Patrizia
P
Ferroni
Fiorella
F
Guadagni
Anastasia
A
Laudisi
Matteo
M
Vergati
Silvia
S
Riondino
Antonio
A
Russo
Giovanni
G
Davì
Mario
M
Roselli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D017671:Platinum Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000139:chemically induced*; D055815:Young Adult
D000970:Antineoplastic Agents; D017671:Platinum Compounds; D003404:Creatinine
Platinum-based chemotherapy; Renal impairment; Risk prediction; Risk stratification; Toxicity; Venous thromboembolism