TY - JOUR
T1 - CamGFR v2
T2 - a new model for estimating the glomerular filtration rate from standardized or non-standardized creatinine in patients with cancer
AU - Williams, Edward H
AU - Flint, Thomas R
AU - Connell, Claire M
AU - Giglio, Daniel
AU - Lee, Hassal
AU - Ha, Taehoon
AU - Gablenz, Eva
AU - Bird, Nicholas J
AU - Weaver, James M J
AU - Potts, Harry
AU - Whitley, Cameron T
AU - Bookman, Michael A
AU - Lynch, Andy G
AU - Meyer, Hannah V
AU - Tavaré, Simon
AU - Janowitz, Tobias
N1 - Funding: This work was supported, in part, by Developmental Funds from the Cold Spring Harbor Laboratory (CSHL) Cancer Center Support grant 5P30CA045508. Funding is acknowledged from Cancer Research UK (to E.H. Williams, S. Tavaré, T. Janowitz, and A.G. Lynch), from CSHL (to T. Ha, H.V. Meyer, and T. Janowitz), from the
Simons Center for Quantitative Biology (to H.V. Meyer), from the Pershing Square
Foundation (to T. Janowitz), from The Experimental Medicine Training Initiative (to
C.M. Connell), from the National Institute for Health Research UK (to J.M.J.Weaver),
and from a Carl-Duisberg Scholarship and a German National Merit Scholarship (to
E. Gablenz). S. Tavaré is a consultant for Kallyope, Inc.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Purpose: Management of patients with cancer, specifically carboplatin dosing, requires accurate knowledge of glomerular filtration rate (GFR). Direct measurement of GFR is resource limited. Available models for estimated GFR (eGFR) are optimized for patients without cancer and either isotope dilution mass spectrometry (IDMS)- or non-IDMS–standardized creatinine measurements. We present an eGFR model for patients with cancer compatible with both creatinine measurement methods.Experimental Design: GFR measurements, biometrics, and IDMS- or non-IDMS–standardized creatinine values were collected for adult patients from three cancer centers. Using statistical modeling, an IDMS and non-IDMS creatinine-compatible eGFR model (CamGFR v2) was developed. Its performance was compared with that of the existing models Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Full Age Spectrum (FAS), Lund–Malmö revised, and CamGFR v1, using statistics for bias, precision, accuracy, and clinical robustness.Results: A total of 3,083 IDMS- and 4,612 non-IDMS–standardized creatinine measurements were obtained from 7,240 patients. IDMS-standardized creatinine values were lower than non-IDMS–standardized values in within-center comparisons (13.8% lower in Cambridge; P < 0.0001 and 19.3% lower in Manchester; P < 0.0001), and more consistent between centers. CamGFR v2 was the most accurate [root-mean-squared error for IDMS, 14.97 mL/minute (95% confidence interval, 13.84–16.13) and non-IDMS, 15.74 mL/minute (14.86–16.63)], most clinically robust [proportion with >20% error of calculated carboplatin dose for IDMS, 0.12 (0.09–0.14) and non-IDMS, 0.17 (0.15–0.2)], and least biased [median residual for IDMS, 0.73 mL/minute (−0.68 to 2.2) and non-IDMS, −0.43 mL/minute (−1.48 to 0.91)] eGFR model, particularly when eGFR was larger than 60 ml/minute.Conclusions: CamGFR v2 can utilize IDMS- and non-IDMS–standardized creatinine measurements and outperforms previous models. CamGFR v2 should be examined prospectively as a practice-changing standard of care for eGFR-based carboplatin dosing.
AB - Purpose: Management of patients with cancer, specifically carboplatin dosing, requires accurate knowledge of glomerular filtration rate (GFR). Direct measurement of GFR is resource limited. Available models for estimated GFR (eGFR) are optimized for patients without cancer and either isotope dilution mass spectrometry (IDMS)- or non-IDMS–standardized creatinine measurements. We present an eGFR model for patients with cancer compatible with both creatinine measurement methods.Experimental Design: GFR measurements, biometrics, and IDMS- or non-IDMS–standardized creatinine values were collected for adult patients from three cancer centers. Using statistical modeling, an IDMS and non-IDMS creatinine-compatible eGFR model (CamGFR v2) was developed. Its performance was compared with that of the existing models Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Full Age Spectrum (FAS), Lund–Malmö revised, and CamGFR v1, using statistics for bias, precision, accuracy, and clinical robustness.Results: A total of 3,083 IDMS- and 4,612 non-IDMS–standardized creatinine measurements were obtained from 7,240 patients. IDMS-standardized creatinine values were lower than non-IDMS–standardized values in within-center comparisons (13.8% lower in Cambridge; P < 0.0001 and 19.3% lower in Manchester; P < 0.0001), and more consistent between centers. CamGFR v2 was the most accurate [root-mean-squared error for IDMS, 14.97 mL/minute (95% confidence interval, 13.84–16.13) and non-IDMS, 15.74 mL/minute (14.86–16.63)], most clinically robust [proportion with >20% error of calculated carboplatin dose for IDMS, 0.12 (0.09–0.14) and non-IDMS, 0.17 (0.15–0.2)], and least biased [median residual for IDMS, 0.73 mL/minute (−0.68 to 2.2) and non-IDMS, −0.43 mL/minute (−1.48 to 0.91)] eGFR model, particularly when eGFR was larger than 60 ml/minute.Conclusions: CamGFR v2 can utilize IDMS- and non-IDMS–standardized creatinine measurements and outperforms previous models. CamGFR v2 should be examined prospectively as a practice-changing standard of care for eGFR-based carboplatin dosing.
U2 - 10.1158/1078-0432.CCR-20-3201
DO - 10.1158/1078-0432.CCR-20-3201
M3 - Article
C2 - 33303580
SN - 1078-0432
VL - 27
SP - 1381
EP - 1390
JO - Clinical Cancer Research
JF - Clinical Cancer Research
IS - 5
ER -
