Introduction:
CKD patients have an increased risk of developing cancer, and cancer patients often present with impaired renal function, which can complicate treatment decisions like drug selection, dosing and eligibility for clinical trials. There is a lack of consensus on the best method for estimating glomerular filtration rate (eGFR) in cancer patients. This study attempts to determine the prevalence of renal insufficiency in patients with newly diagnosed cancer, as well as the demographic data comorbidities, clinical outcomes and survival at six months follow-up
Methods:
This cross-sectional retrospective study included 350 consecutive newly diagnosed cancer patients above 18. The basic demographics, type of cancer with stage, risk factors, serum creatinine at presentation and 6 months, treatment and clinical outcome were ascertained from the hospital records. GFR was assessed using three different equations: CKD-EPI, MDRD, and Cockcroft-Gault formula. The eGFR values below 60 ml/min or serum creatinine values more than 1.2mg/dl were used to define renal insufficiency at presentation. The relationship between eGFR at presentation and patient survival was analyzed to understand the impact of renal insufficiency on treatment outcomes. All the statistical analysis was carried out at 5% level of significance
Results:
The median age of the study population was 54 years; 51.1% were women. At the time of presentation, 11.43% of patients had an eGFR below 60 ml/min and 38.9% had an eGFR below 90 ml/min by CKD-EPI equation. Multiple myeloma patients had the highest prevalence of reduced eGFR, with 52.63% having an eGFR below 60 ml/min. Among patients with serum creatinine less than 1.2 mg/dl at presentation, 7 patients (2.87%) had eGFR less than 60 ml/min, and 78 patients (25.55%) had eGFR less than 90 ml/min calculated by CKD-EPI equation.
At six months, the mortality rate was significantly higher in patients with advanced stages of CKD (70%) compared to those in the earlier stages (33%). Nephrotoxic chemotherapy agents were prescribed, with 53.8% of patients requiring dose adjustments based on their renal function. With Cockroft Gault equation 27.72% of patients had CrCl <60 ml/min, with MDRD (4 variable) equation 13.7% had eGFR <60ml/min and when using CKD-EPI equation for calculating eGFR, 11.21% of patients were found to have eGFR<60ml/min (for the 321 patients for whom weight and height data was available, as these variables were used for calculating by the Cockroft Gault equation)
Conclusions:
The prevalence of renal insufficiency was 11.43% among newly diagnosed cancer patients, Cancer patients with advanced stages of CKD have poor survival at six months when compared to those with no CKD or earlier stages of CKD. The serum creatinine levels alone were insufficient to detect renal insufficiency, as a proportion of patients with normal serum creatinine had reduced eGFR. Most chemotherapeutic agents used either required dose modification for renal dysfunction or were nephrotoxic. As it has significant clinical implications it is crucial to incorporate routine eGFR calculation into clinical practice for cancer patients and the findings of this will require validation in a larger prospective cohort
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.