We searched PubMed for literature discussing the performance of GFR estimating equations in patients with malignancy to create a table of the evidence for creatinine- and cystatin c-based equations. We further reviewed novel estimation techniques such as panel eGFR, real-time measured GFR, and functional magnetic resonance imaging.
The commonly used GFR estimating equations were derived from populations of patients without cancer. These equations may be less applicable in Oncology due to severe sarcopenia, inflammation, and other physiologic changes in patients with cancer. The Cockcroft-Gault equation currently dominates in clinical Oncology despite significant limitations and accumulating evidence for use of the CKD-EPICr formula. Additional considerations in the practice of Oncology include a recently developed equation (CamGFRv2, also called the Janowitz formula) and the use of cystatin c-based equations to overcome some of the barriers to accurate GFR estimation based on creatinine alone.
Overall, we suggest using the CKD-EPI equations (either cystatin c or creatinine-based) among patients with cancer in routine clinical practice and measured GFR for patients at a critical threshold for treatment decisions.
方法:我们搜索了PubMed的文献,讨论了GFR估计方程在恶性肿瘤患者中的性能,以创建基于肌酐和胱抑素c的方程的证据表。我们进一步回顾了新的估计技术,如面板eGFR,实时测量GFR,和功能磁共振成像。
结果:常用的GFR估计方程来自没有癌症的患者群体。由于严重的肌少症,这些方程可能不太适用于肿瘤学,炎症,以及癌症患者的其他生理变化。Cockcroft-Gault方程目前在临床肿瘤学中占主导地位,尽管存在明显的局限性,并且越来越多的证据表明使用CKD-EPICr公式。肿瘤学实践中的其他考虑因素包括最近开发的方程(CamGFRv2,也称为Janowitz公式)和使用基于胱抑素c的方程来克服仅基于肌酐的准确GFR估计的一些障碍。
结论:总体而言,我们建议在常规临床实践中在癌症患者中使用CKD-EPI方程(基于胱抑素c或基于肌酐),并在治疗决策的关键阈值测量患者的GFR。