Estimating GFR In Oncology Patients Receiving Cisplatin Chemotherapy : Predicted Creatinine Clearance Against Tc-99m Dtpa Methods
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Date
2016
Authors
Syed Sahab, Sharifah Khaidah
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Objective:
To analyze the incidence of Cisplatin induced nephrotoxicity in oncology patients through
GFR estimation pre and post chemotherapy using 99mTc-DTPA plasma sampling as
reference method and to compare with predicted creatinine clearance and Tc-99m renal
scintigraphy.
Methodology/ Study Design:
A prospective study of 33 patients referred to the Department of Nuclear Medicine, Hospital
Pulau Pinang for 99mTc-DTPA scan between 1 February 2014 and 30 April 2015. This study
was performed to analyze the incidence of cisplatin induced nephrotoxicity among the
oncology patients via the radionuclide and creatinine-based method of GFR estimation. Out
of 33 adults referred, only 21 are included in the study.
Results:
From the 21 patients included in the study, 16 (76.2%) are male and 5 (23.8%) are female.
The mean age of patients is 55.1 (10.80). The dose of Cisplatin given was 75mg/m2 for each
cycle up to three cycles. The mean difference of GFR pre and post chemotherapy as given by
the PSC 2 method was 13.38 (-4.60, 31.36) ml/min/1.73m2 (p 0.136). Of 21 patients, 3 were
found to have severe nephrotoxicity (GFR < 50ml/min/1.73m2) contributing 14.3% of
incidence. Bland-Altman plot showed only PSC 1 is in agreement with PSC 2 technique.
Intraclass Correlation Coefficients (ICC) also showed that PSC 1 has high degree of
reliability in comparison to PSC 2 method (p< 0.001). The rest of the methods, namely the
CG, MDRD, CKD-EPI and Gates methods do not show reliability and agreement in
comparison to PSC 2 method (p< 0.05).
Conclusion:
Radionuclide method for evaluating GFR is the most sensitive method for the
detection of Cisplatin induced nephrotoxicity. 3 of 21 patients were found to develop severe
nephrotoxicity (GFR < 50ml/min/1.73m2) in this small number of samples by both PSC 1
and PSC 2 methods. PSC 1 method was found to be a reliable substitute of PSC 2. The rest of
the methods, namely the CG, MDRD, CKD-EPI and Gates are not reliable for detection of
early nephrotoxicity. We will recommend the use of one plasma sampling method (PSC 1)
for GFR estimation in monitoring post Cisplatin chemotherapy patients.
Description
Keywords
Estimating GFR In Oncology Patients , Receiving Cisplatin Chemotherapy