악성종양 환자에서의 사구체 여과율 평가법 비교
Evaluation of a Predictive Formula for Glomerular Filtration Rate in Malignancy
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Accurate assessment of kidney function is necessary for patients with malignancies who are given renally clearing chemotherapy or nephrotoxic drugs. Creatinine clearance (CrCl) as a parameter to evaluate the glomerular filtration rate (GFR) of the kidney can be measured using a 24 hour urine collection (24hr-CrCl) or estimated by several predictive formulas using serum creatinine (Scr). Since these all have their limitations, this study was performed to find a more accurate formula for estimating renal function in malignancy. Patients with a malignancy who had their 24hr-CrCl done at Samsung Medical Center from January 2008 to May 2012 were reviewed retrospectively. Four hundred and fifty one patients were evaluated: males were 268 and female 183, the median age was 52 years (range 20-82), and Scr was 1.0 mg/dL (range 0.26-7.51) and mean 24hr-CrCl 103.6 mL/min. The estimation of all formulas was not different from the 24hr-CrCl, with the exception of the Wright formula (p<0.001). The absolute Modification of Diet in Renal Disease (MDRD) was less biased and more precise than the MDRD however, the proximate estimation of both formulas was limited to patients with a 24hr-CrCl of <50 mL/min (p=0.21, p=0.33). The Cockcroft-Gault (CG) estimation was the most accurate, and it was not different from the 24hr-CrCl over a broad range of renal function (bias 1.91, 2.45, -0.48% in 24hr-CrCl<50, 50-100, >100mL/min). It is difficult to estimate the individual GFR over a broad range accurately with only one formula,however, these observations suggest that the CG provides a relatively good estimate of the 24hr-CrCl in general. Additionally, the use of the absolute MDRD can be considered in patients whose renal function has decreased, however, the Wright formula which significantly overestimated the 24hr-CrCl by 13.80%, showed limited applicability.
Abstract
Accurate assessment of kidney function is necessary for patients with malignancies who are given renally clearing chemotherapy or nephrotoxic drugs. Creatinine clearance (CrCl) as a parameter to evaluate the glomerular filtration rate (GFR) of the kidney can be measured using a 24 hour urine collection (24hr-CrCl) or estimated by several predictive formulas using serum creatinine (Scr). Since these all have their limitations, this study was performed to find a more accurate formula for estimating renal function in malignancy. Patients with a malignancy who had their 24hr-CrCl done at Samsung Medical Center from January 2008 to May 2012 were reviewed retrospectively. Four hundred and fifty one patients were evaluated: males were 268 and female 183, the median age was 52 years (range 20-82), and Scr was 1.0 mg/dL (range 0.26-7.51) and mean 24hr-CrCl 103.6 mL/min. The estimation of all formulas was not different from the 24hr-CrCl, with the exception of the Wright formula (p<0.001). The absolute Modification of Diet in Renal Disease (MDRD) was less biased and more precise than the MDRD however, the proximate estimation of both formulas was limited to patients with a 24hr-CrCl of <50 mL/min (p=0.21, p=0.33). The Cockcroft-Gault (CG) estimation was the most accurate, and it was not different from the 24hr-CrCl over a broad range of renal function (bias 1.91, 2.45, -0.48% in 24hr-CrCl<50, 50-100, >100mL/min). It is difficult to estimate the individual GFR over a broad range accurately with only one formula,however, these observations suggest that the CG provides a relatively good estimate of the 24hr-CrCl in general. Additionally, the use of the absolute MDRD can be considered in patients whose renal function has decreased, however, the Wright formula which significantly overestimated the 24hr-CrCl by 13.80%, showed limited applicability.
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