比较肾功能正常的肺癌患者肾小球滤过率的三种估算公式,以预测顺铂相关的急性肾损伤。

IF 1.4 4区 医学 Q4 ONCOLOGY
Kubilay Karaboyun, Yakup İriağaç, Eyyüp Çavdar, Okan Avci, Erdoğan S Şeber
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引用次数: 0

摘要

目的:顺铂相关急性肾损伤是一种常见的临床症状,即使被归类为肾功能正常的癌症患者也会因此增加发病率和死亡率。我们旨在通过比较化疗前分别用 Cockcroft and Gault (CG)、肾病饮食改良 (MDRD) 和慢性肾病流行病学协作组织 (CKD-EPİ) 方程计算的估计肾小球滤过率以及患者相关因素,确定可预测肾功能正常患者顺铂治疗相关急性肾损伤的预测因素:这项回顾性研究共纳入了 200 名确诊为肺癌的患者,这些患者在化疗前被主治医生确定为肾功能正常且符合顺铂治疗条件。顺铂化疗后急性肾损伤(c-AKI)是根据美国国立癌症研究所的不良事件通用术语标准 v4.03 确定的。化疗前的血清实验室参数和患者的临床组织病理学特征均由医院电子系统记录。eGFR方法的最佳临界值通过接收者操作特征曲线下面积(ROC-AUC)分析确定。c-AKI 的预测因素分析通过回归分析进行:结果:39 例(19.5%)患者发生了 C-AKI。在单变量分析中,观察到 c-AKI 与治疗前高体重指数(BMI)、高龄(大于 62.5 岁)、女性性别、MDRD 的 eGFR(≤94.5 mL/min)和 CKD-EPI 的 eGFR(≤91.5 mL/min)之间存在显著相关性。CG的eGFR与c-AKI之间没有关系。建立了两个不同的多变量模型。模型 1 显示,女性性别(几率比 [OR] =4.90,95% 置信区间 [CI]:1.52-15.79,P =0.008)和按 MDRD 计算的 eGFR 小于或等于 94.5 mL/min(OR =3.52,95% CI:1.68-7.38,P =0.001)是 c-AKI 的预测指标。在多变量模型 2 中,发现女性性别(OR = 5.51,95% CI:1.70-17.83,P = 0.004)和根据 CKD-EPI 计算的 eGFR 小于或等于 91.5 mL/min(OR = 3.52,95% CI:1.67-7.42,P = 0.001)是 c-AKI 的预测指标:本研究显示,化疗前根据MDRD(≤94.5 mL/min/m2)或CKD-EPI(≤91.5 mL/min/m2)计算的eGFR表明有强烈的c-AKI倾向。此外,与女性患者相比,我们发现女性患者发生 c-AKI 的风险较高。虽然 eGFR 60 mL/min 被认为是接受符合顺铂条件的患者的临界值,但我们建议对我们的模型中发现的顺铂肾毒性高风险患者进行密切随访。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of three equations for estimating glomerular filtration rate as predictors of cisplatin-related acute kidney injury in lung cancer patients with normal renal function.

Objective: Cisplatin-associated acute kidney injury is a common clinical event that causes increased morbidity and mortality in cancer patients even if they are categorized as having normal functioning kidneys. We aimed to determine predictive factors that can predict acute kidney injury associated with cisplatin therapy in patients with normal renal function by comparison of pre-chemotherapy estimated glomerular filtration rates calculated separately by Cockcroft and Gault (CG), the Modification of Diet in Renal Disease (MDRD), and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPİ) equations and accompanying patient-associated factors.

Materials and methods: A total of 200 patients diagnosed with lung cancer and determined to have normal functioning kidneys and considered cisplatin eligible by the attending physician before chemotherapy were included in this retrospective study. Acute kidney injury after cisplatin chemotherapy (c-AKI) was determined according to the National Cancer Institute's Common Terminology Criteria for Adverse Events v4.03. Pre-chemotherapy serum laboratory parameters and clinico-histopathological characteristics of patients were recorded from the hospital electronic system. The optimal cut-off for eGFR methods was determined by the area under the receiver operating characteristic curve (ROC-AUC) analysis. Predictive factor analysis for c-AKI was performed by regression analyses.

Results: C-AKI developed in 39 (19.5%) patients. In the univariate analysis, a significant correlation was observed between c-AKI and high body mass index (BMI) before treatment, older age (>62.5), female gender, eGFR by MDRD (≤94.5 mL/min) and eGFR by CKD-EPI (≤91.5 mL/min). There was no relation between eGFR by CG and c-AKI. Two different multivariate models were established. Model 1 showed that female gender (odds ratio [OR] =4.90, 95% confidence interval [CI]: 1.52-15.79, P = 0.008) and eGFR by MDRD less than or equal to 94.5 mL/min (OR = 3.52, 95% CI: 1.68-7.38, P = 0.001) were predictive markers for c-AKI. In Multivariate Model 2, female gender (OR = 5.51, 95% CI: 1.70-17.83, P = 0.004) and eGFR by CKD-EPI less than or equal to 91.5 mL/min (OR = 3.52, 95% CI: 1.67-7.42, P = 0.001) were found to be predictive markers for c-AKI.

Conclusions: This study revealed that eGFR calculated based on MDRD (≤94.5 mL/min/m2) or CKD-EPI (≤91.5 mL/min/m2) before chemotherapy indicates a strong tendency for c-AKI. In addition, we detected a high risk of c-AKI for females compared to their counterparts. Although eGFR 60 mL/min is considered the threshold level to accept patients as cisplatin-eligible, we recommend close follow-up of high-risk patients for cisplatin nephrotoxicity we detected in our models.

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来源期刊
CiteScore
1.80
自引率
15.40%
发文量
299
审稿时长
6 months
期刊介绍: The journal will cover technical and clinical studies related to health, ethical and social issues in field of Medical oncology, radiation oncology, medical imaging, radiation protection, non-ionising radiation, radiobiology. Articles with clinical interest and implications will be given preference.
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