Cisplatin chemotherapy:

Creatinine Clerance VS Glomerular Filtration Rate

Marendra Mahathir

Supervisor:
Dr. dr. Tofan Widya Utami, OBGYN (C)

Obstetric & Gynecology Department

Faculty of Medicine, University of Indonesia
Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo
 Learning Objective
• Understand the burden discrepancy between
serum creatinine level and glomerular filtration rate
in cancer patient with history of nephrotoxic drugs
in chemotherapy.

• Give a recommendation to renal function

assessment fot nephrotoxic drugs in clinical practice
 Case Ilustration
Mrs. Novieta I, 40 yo, 4338219 (December 4th, 2018)
• Chief complain of vaginal bleeding since 6 months
before admission
• Patient referred from Fatmawati hospital with
diagnose cervical cancer stadium IIIB.
• Patient was complain of post coital bleeding
• Already perform biopsy and the result is carcinoma
cell squamous. plan for chemo radiotherapy.
• Until January 21th, 2019 patients already got
cisplatin chemotherapy and 21 times of external
radiotherapy
 Case Ilustration
.
• Before got the chemotherapy, the renal function of
the patient always evaluate with Creatinine
clearance and glomerular filtration rate with
Cockcroft–Gault formula
Date Creatinin eGFR CCT Cr Urin Urine
volume
21/01/2019 0.6 114 94.8 22.8 3125
14/01/2019 0.6 114.4 102 18.4 4200
11/01/2019 0.6 115
02/01/2019 0.6 114 78.58 16.4 3600
20/12/2018 0.6 114
04/12/2018 0.6 114
 Background
• Renal function assessment is critical in determining
the eligibility or need to dose modification of
nephrotoxic drugs in clinical practice
• Measuring creatinine clearance and glomerular
filtration rate (GFR) are widely accepted index of
renal function
• there are some situations in which patients may be
suffer significant renal impairment though serum
creatinine levels remain within normal ranges
 Problem
• Is the method of GFR assessment can replace the
Creatinine clearence method to evaluate renal
function before perform cisplatin chemotheraphy?
 PICO
Description

Population cancer patient treat

nephrotoxic chemotheraphy
Intervention Creatinine clearance
Comparation Glomerular filtration rate
Outcome the renal function
 Evident Search Methodology
PubMed (Advanced Search):
Cisplatin AND ckd epi AND Cockcroft-Gault
formula AND creatinine clearance

PubMed n=52

Papers for review of title and type

of article relevant n=2

• Relevant article n=2

 Discussion

• Retrospective study
• For each patient, GFR was estimated by Cockcroft and Gault equation

• Estimated GFR (eGFR) was classified as:

o normal (eGFR ≥ 60 mL/min and eligible for full dose cisplatin)
o borderline (45 ≤ eGFR < 60 mL/min and eligible for modified dose cisplatin)
o low (eGFR < 45 mL/min and ineligible for cisplatin)
• The discordance between SCr and CG calculated eGFR values were most
pronounced in the older age, transitional cell carcinoma histology and
bladder primary site
 Discussion
• In this study suggests that serum creatinine level
may not be a reliable indicator of renal sufficiency
in cancer patients candidated for cisplatin-based
chemotherapy
• Kannapiran et al in their study on 928 out patients
showed that 270 patients (29.1%) had renal
dysfunction. However, with SCr only 162 (17.5%)
patients had abnormal renal function and SCr
values misrepresented 108 (11.6%) patients with
impaired kidney function.
 Discussion
• Yohei Funakoshi, et al,. Study about Validity of new
methods to evaluate renal function in cancer
patients treated with cisplatin
• there lower bias and higher precision values were
obtained using the CKD–EPI than using 24-h Ccr in
cancer patients
• before and after chemotherapy with cisplatin.
Therefore, it is recommended to use CKD-EPI
instead of Ccr for the evaluation of renal function
when cisplatin-containing chemotherapy is used
 Conclusion
• It is recommended to evaluate the renal function
using eGFR rather than SCr for cancer patient treat
with cisplatin chemotheraphy
• Using only SCr level may not be a reliable index of
normal renal function in considering patients for
cisplatine based chemotherapy