细胞毒化疗药物剂量：肾功能评估对剂量的影响。

Dosing of cytotoxic chemotherapy: impact of renal function estimates on dose.

机构信息

Department of Pharmacy, Alfred Health, Melbourne.

出版信息

Ann Oncol. 2013 Nov;24(11):2746-52. doi: 10.1093/annonc/mdt300. Epub 2013 Aug 7.

DOI:10.1093/annonc/mdt300

PMID:23928359

Abstract

BACKGROUND

Oncology clinicians are now routinely provided with an estimated glomerular filtration rate on pathology reports whenever serum creatinine is requested. The utility of using this for the dose determination of renally excreted drugs compared with other existing methods is needed to inform practice.

PATIENTS AND METHODS

Renal function was determined by [Tc(99m)]DTPA clearance in adult patients presenting for chemotherapy. Renal function was calculated using the 4-variable Modification of Diet in Renal Disease (4v-MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockcroft and Gault (CG), Wright and Martin formulae. Doses for renal excreted cytotoxic drugs, including carboplatin, were calculated.

RESULTS

The concordance of the renal function estimates according to the CKD classification with measured Tc(99m)DPTA clearance in 455 adults (median age 64.0 years: range 17-87 years) for the 4v-MDRD, CKD-EPI, CG, Martin and Wright formulae was 47.7%, 56.3%, 46.2%, 56.5% and 60.2%, respectively. Concordance for chemotherapy dose for these formulae was 89.0%, 89.5%, 85.1%, 89.9% and 89.9%, respectively. Concordance for carboplatin dose specifically was 66.4%, 71.4%, 64.0%, 73.8% and 73.2%.

CONCLUSION

All bedside formulae provide similar levels of concordance in dosage selection for the renal excreted chemotherapy drugs when compared with the use of a direct measure of renal function.

摘要

背景

每当需要检测血清肌酐时，肿瘤临床医生现在通常会在病理报告中提供估计肾小球滤过率。需要了解与其他现有方法相比，使用这种方法来确定肾排泄药物的剂量在实践中的效用。

患者和方法

在接受化疗的成年患者中，通过 [Tc(99m)]DTPA 清除率来确定肾功能。使用 4 变量修正肾脏病饮食法（4v-MDRD）、慢性肾脏病流行病学合作（CKD-EPI）、 Cockcroft 和 Gault（CG）、Wright 和 Martin 公式计算肾功能。计算了肾排泄细胞毒性药物（包括卡铂）的剂量。

结果

在 455 名成年人（中位年龄 64.0 岁：范围 17-87 岁）中，根据 CKD 分类，4v-MDRD、CKD-EPI、CG、Martin 和 Wright 公式计算的肾功能估计值与实测 Tc(99m)DPTA 清除率的一致性分别为 47.7%、56.3%、46.2%、56.5%和 60.2%。对于这些公式，化疗剂量的一致性分别为 89.0%、89.5%、85.1%、89.9%和 89.9%。特异性卡铂剂量的一致性分别为 66.4%、71.4%、64.0%、73.8%和 73.2%。