Titan Silvia M, Lieske John C, Meeusen Jeffrey W, Thorson Stacy, Lin Yi, Nowakowski Grzegorz S, Barreto Jason N, Barreto Erin F, Ruddy Kathryn J, Leung Nelson, Rule Andrew D, Herrmann Sandra M
Nephrology and Hypertension Division, Mayo Clinic, Rochester, Minnesota.
Biomedical Informatics, Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota.
Clin J Am Soc Nephrol. 2025 Mar 1;20(3):358-366. doi: 10.2215/CJN.0000000616. Epub 2025 Feb 10.
Studies on GFR assessment in people with cancer are needed. In this study, the creatinine–cystatin C equations performed better than other equations, and this was observed in solid and hematological cancers. Our findings give support to the preferential use of creatinine and cystatin C–based equations in people with cancer.
GFR assessment is important in clinical practice with implications for diagnosis, prognostication, and drug dosing. People with cancer are at risk of imprecision in GFR estimation. This cross-sectional study evaluated the performance of various creatinine and cystatin C–based equations in comparison with measured GFR (mGFR) in people with cancer.
We retrieved data for all adult patients who had mGFR by urinary iothalamate clearance between 2011 and 2023 at Mayo Clinic and use of an electronic health record diagnosis code for cancer within 2 years before mGFR. The CKD Epidemiology Collaboration (CKD-EPI), European Kidney Function Consortium, and Cockcroft–Gault equations were computed, along with performance metrics (bias, precision, and root mean square error [RMSE]. Confidence intervals were generated by bootstrapping, and analysis were stratified by solid and hematological cancers.
From all adults with cancer and mGFR, 1145 had both creatinine and cystatin C available within 7 days of mGFR. Among all equations, the creatinine–cystatin C CKD-EPI equation provided the best performance, with small bias (median, 3.0; 95% confidence interval, 2.3 to 3.8) and higher precision (RMSE, 14.5) compared with creatinine-only or cystatin C–only equations (RMSE varying from 16.6 to 20), and this was also true in solid and hematological cancers. The creatinine–cystatin European Kidney Function Consortium equation had a similar performance to CKD-EPI, Cockcroft–Gault showed worst precision (30% of people with errors above 30%), and cystatin C CKD-EPI equation was the most biased, prone to underestimation of mGFR.
In our cohort of patients with mGFR and cancer, the CKD-EPI creatinine–cystatin C equation performed best for GFR assessment, and this was true for both solid and hematological cancers. Our findings give support for the preferential use of creatinine and cystatin C–based equations instead of creatinine-only or cystatin C–only equations in people with cancer.
需要开展针对癌症患者肾小球滤过率（GFR）评估的研究。在本研究中，肌酐-胱抑素C方程的表现优于其他方程，在实体癌和血液系统癌症患者中均观察到这一情况。我们的研究结果支持在癌症患者中优先使用基于肌酐和胱抑素C的方程。
GFR评估在临床实践中很重要，对诊断、预后及药物剂量确定均有影响。癌症患者存在GFR估算不准确的风险。这项横断面研究比较了各种基于肌酐和胱抑素C的方程与测量的GFR（mGFR）在癌症患者中的表现。
我们检索了2011年至2023年在梅奥诊所通过碘他拉酸钠清除率测定mGFR且在mGFR测定前2年内使用电子健康记录诊断代码诊断为癌症的所有成年患者的数据。计算了慢性肾脏病流行病学协作组（CKD-EPI）、欧洲肾功能协会及考克洛夫特-高尔特方程，并计算了性能指标（偏差、精密度和均方根误差[RMSE]）。通过自抽样生成置信区间，并按实体癌和血液系统癌症进行分层分析。
在所有患有癌症且测定了mGFR的成年人中，1145例在mGFR测定后7天内同时有肌酐和胱抑素C数据。在所有方程中，肌酐-胱抑素C的CKD-EPI方程表现最佳，偏差小（中位数为3.0；95%置信区间为2.3至3.8），与仅使用肌酐或仅使用胱抑素C的方程相比精密度更高（RMSE为14.5）（RMSE在16.6至20之间），在实体癌和血液系统癌症患者中也是如此。肌酐-胱抑素欧洲肾功能协会方程的表现与CKD-EPI相似，考克洛夫特-高尔特方程的精密度最差（30%的人的误差超过30%），胱抑素C的CKD-EPI方程偏差最大，容易低估mGFR。
在我们这个测定了mGFR的癌症患者队列中，CKD-EPI肌酐-胱抑素C方程在GFR评估方面表现最佳，在实体癌和血液系统癌症患者中均如此。我们的研究结果支持在癌症患者中优先使用基于肌酐和胱抑素C的方程，而非仅使用肌酐或仅使用胱抑素C的方程。
