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J Geriatr Oncol. 2017 Mar;8(2):96-101. doi: 10.1016/j.jgo.2016.10.004. Epub 2016 Nov 14.

Association between renal function and chemotherapy-related toxicity in older adults with cancer.

Author information

1
Washington University School of Medicine, St. Louis, MO, United States. Electronic address: llpeterson@wustl.edu.
2
City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States.
3
University of Rochester, Rochester, NY, United States.
4
Case Western Reserve University, Cleveland, OH, United States.
5
Wake Forest University School of Medicine, Winston-Salem, NC, United States.
6
Yale Comprehensive Cancer Center, New Haven, CT, United States.
7
Memorial Sloan-Kettering Cancer Center, United States.
8
State University of New York Upstate Medical University and Veterans Administration Medical Center, Syracuse, NY, United States.

Abstract

PURPOSE:

To evaluate the association between renal function (RF) and chemotherapy-related toxicity (CRT) in older adults with cancer and to compare the effect of different RF formulas and body weight measurements on this association.

METHODS:

This is a secondary analysis of data from a prospective multicenter study of patients ≥ age 65 who were starting a new chemotherapy regimen. RF was estimated with 4 formulas (modified Jelliffe [Jelliffe], Cockcroft-Gault [CG], Wright, and Modification of Diet in Renal Disease [MDRD]), using actual, ideal and adjusted body weights for 492 patients. The association between baseline RF and grade 3-5 CRT was evaluated by unconditional logistic regression.

RESULTS:

As a continuous variable, decreased creatinine clearance (CrCl) calculated by CG with actual body weight was associated with increased odds of CRT (OR 1.12, P<0.01; 95% CI 1.04-1.20) indicating that on average for every 10mL/min decrease in CrCl the odds of CRT increased by 12%. Very low RF (in the lowest 10%) with all formulas (CG, Jelliffe, Wright and MDRD) was associated with increased odds for CRT. This association is independent of the type of chemotherapy received (those requiring dose adjustment for renal function vs not). Neither primary dose reduction nor chemotherapy duration was associated with CRT. Serum creatinine alone was not associated with increased odds of CRT (OR 0.67, P=0.15).

CONCLUSIONS:

Decreased RF is associated with increased odds of CRT and should be considered when assessing risk of CRT in older adults with cancer. Serum creatinine alone is not adequate for risk assessment.

KEYWORDS:

Chemotherapy toxicity; Creatinine clearance; Older adults; Renal function

PMID:
27856262
PMCID:
PMC5373948
DOI:
10.1016/j.jgo.2016.10.004
[Indexed for MEDLINE]
Free PMC Article

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