Aligning kidney function assessment in patients with cancer to global practices in internal medicine

Geeta Sandhu^{1

2

3}, Josephine Adattini², Evangeline Armstrong Gordon², Niamh O'Neill², Corrine Bagnis⁴, Pinkie Chambers⁵, Jennifer H Martin⁶, Alex Flynn⁶, Karim Ibrahim⁷, Meg J Jardine^{8

9}, David W Johnson^{10

11

12}, Graham R D Jones^{7

13}, Christos S Karapetis¹⁴, Aisling Kelly², Ganessan Kichenadasse¹⁴, David S Kliman¹⁵, Winston Liauw^{16

17}, Catherine Lucas⁶, Andrew J Mallett^{18

19

20}, Jolanta Malyszko²¹, Michael Michael^{22

23}, Carol A Pollock^{1

24}, Darren M Roberts²⁵, Mitchell H Rosner²⁶, David J M Routledge^{22

27}, Carla Scuderi^{28

29}, Julia Shingleton², Jake Shortt^{30

31}, Jim Siderov³², Ben Sprangers^{33

34}, Brian N Stein^{35

36}, David J Tunnicliffe^{37

38}, Kate Webber^{31

39}, Robyn L Ward^{1

2}; ADDIKD Working Group

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² eviQ, Cancer Institute NSW, St Leonards, NSW, Australia.
³ Pharmacy Department, St Vincent's Hospital, Sydney, NSW, Australia.
⁴ Nephrology Department, APHP Sorbonne University, Paris, France.
⁵ University College London School of Pharmacy and University College London Hospital-University College London Centre for Medicines Optimisation Research and Education, London, United Kingdom.
⁶ Centre for Drug Repurposing, University of Newcastle, Newcastle, NSW, Australia.
⁷ Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia.
⁸ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
⁹ Concord Repatriation General Hospital, Concord, NSW, Australia.
¹⁰ Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD, Australia.
¹¹ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
¹² Translational Research Institute, Brisbane, QLD, Australia.
¹³ Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, NSW, Australia.
¹⁴ Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Bedford Park, SA, Australia.
¹⁵ Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.
¹⁶ Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia.
¹⁷ School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
¹⁸ Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia.
¹⁹ College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia.
²⁰ Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
²¹ Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
²² Peter MacCallum Cancer Centre, Parkville, VIC, Australia.
²³ The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.
²⁴ Kolling Institute Medical Research, Sydney, NSW, Australia.
²⁵ Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
²⁶ Department of Medicine, University of Virginia Health, Charlottesville, VA, USA.
²⁷ Clinical Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia.
²⁸ Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
²⁹ School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
³⁰ Monash Haematology, Monash Health, Clayton, VIC, Australia.
³¹ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
³² Pharmacy Department, Austin Health, Melbourne, VIC, Australia.
³³ Biomedical Research Institute, Department of Immunology and Infection, UHasselt, Diepenbeek, Belgium.
³⁴ Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium.
³⁵ ICON Cancer Centre, Adelaide, SA, Australia.
³⁶ The University of Adelaide, Adelaide, SA, Australia.
³⁷ Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
³⁸ Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
³⁹ Department of Medical Oncology, Monash Health, Clayton, VIC, Australia.

PMID: 40290845
PMCID: PMC12034077
DOI: 10.1016/j.eclinm.2025.103102

Review

Aligning kidney function assessment in patients with cancer to global practices in internal medicine

Geeta Sandhu et al. EClinicalMedicine. 2025.

. 2025 Mar 25:82:103102.

doi: 10.1016/j.eclinm.2025.103102. eCollection 2025 Apr.

Authors

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² eviQ, Cancer Institute NSW, St Leonards, NSW, Australia.
³ Pharmacy Department, St Vincent's Hospital, Sydney, NSW, Australia.
⁴ Nephrology Department, APHP Sorbonne University, Paris, France.
⁵ University College London School of Pharmacy and University College London Hospital-University College London Centre for Medicines Optimisation Research and Education, London, United Kingdom.
⁶ Centre for Drug Repurposing, University of Newcastle, Newcastle, NSW, Australia.
⁷ Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia.
⁸ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
⁹ Concord Repatriation General Hospital, Concord, NSW, Australia.
¹⁰ Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD, Australia.
¹¹ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
¹² Translational Research Institute, Brisbane, QLD, Australia.
¹³ Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, NSW, Australia.
¹⁴ Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Bedford Park, SA, Australia.
¹⁵ Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.
¹⁶ Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia.
¹⁷ School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
¹⁸ Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia.
¹⁹ College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia.
²⁰ Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
²¹ Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
²² Peter MacCallum Cancer Centre, Parkville, VIC, Australia.
²³ The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.
²⁴ Kolling Institute Medical Research, Sydney, NSW, Australia.
²⁵ Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
²⁶ Department of Medicine, University of Virginia Health, Charlottesville, VA, USA.
²⁷ Clinical Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia.
²⁸ Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
²⁹ School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
³⁰ Monash Haematology, Monash Health, Clayton, VIC, Australia.
³¹ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
³² Pharmacy Department, Austin Health, Melbourne, VIC, Australia.
³³ Biomedical Research Institute, Department of Immunology and Infection, UHasselt, Diepenbeek, Belgium.
³⁴ Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium.
³⁵ ICON Cancer Centre, Adelaide, SA, Australia.
³⁶ The University of Adelaide, Adelaide, SA, Australia.
³⁷ Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
³⁸ Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
³⁹ Department of Medical Oncology, Monash Health, Clayton, VIC, Australia.

PMID: 40290845
PMCID: PMC12034077
DOI: 10.1016/j.eclinm.2025.103102

Abstract

The kidney disease: Improving Global Outcomes (KDIGO) guideline recommends assessing kidney function using glomerular filtration rate (GFR) either through direct measurement or through estimation (eGFR) and describes a standardised classification of reduced kidney function. KDIGO guidelines have been adopted by most internal medicine specialities for the assessment and classification of kidney function, but not by cancer medicine. The development of the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) aims to overcome the perceived challenges with KDIGO recommendations by describing their utility in patients with cancer. Two virtual, consensus building workshops were held consecutively, involving international, multidisciplinary participants (Part 1 of ADDIKD development). During these workshops, three consensus recommendations were agreed upon based on KDIGO's principles; to standardise kidney function assessment, classify kidney function, and determine a uniform approach to dose anticancer drugs in patients with reduced kidney function. Cancer clinicians attending the workshops identified issues regarding the adoption of KDIGO's recommendations. These issues were addressed by nephrologists, clinical pharmacologists, and other clinicians with extensive experience in the contemporary assessment of kidney function. The key concern for cancer specialists was a hesitancy to move away from the familiar and long-standing practice of using the Cockcroft-Gault equation to estimate creatinine clearance. The consensus building within the two multidisciplinary workshops allowed a thorough assessment of the evidence and clarified how directly measured GFR and eGFR, rather than creatinine clearance, could be optimally utilised in cancer care. The development of Part 1 of the ADDIKD guideline represents a standardised, contemporary approach to the assessment, classification, and utility of kidney function in the setting of cancer care and it harmonises with the approach used in other areas of medicine internationally.

Funding: Development of the ADDIKD guideline is funded by the Cancer Institute NSW as part of the NSW Government and received no funding from external commercial sources.

Keywords: Chemotherapy; Drug dosing; Haematology; Kidney dysfunction; Oncology; Pharmacokinetics; Renal.

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Conflict of interest statement

AJM reports a relationship with National Health and Medical Research Council that includes: funding grants. AJM reports a relationship with Australian Government Medical Research Future Fund that includes: funding grants. AJM reports a relationship with Queensland Government that includes: funding grants. AJM reports a relationship with Townsville Hospital and Health Service that includes: funding grants. AJM reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: travel reimbursement. AJM reports a relationship with GSK that includes: travel reimbursement. AJM reports a relationship with Australia and New Zealand Society of Nephrology that includes: board membership. BS reports a relationship with Omeros Corporation that includes: consulting or advisory. BS reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees and travel reimbursement. BS reports a relationship with Vifor Pharma Switzerland SA that includes: speaking and lecture fees. BS reports a relationship with Janssen Pharmaceuticals Inc that includes: speaking and lecture fees. BS reports a relationship with Boehringer Ingelheim Corp USA that includes: board membership and speaking and lecture fees. BS reports a relationship with MorphoSys US Inc that includes: board membership. JS reports a relationship with Roche that includes: speaking and lecture fees. JS reports a relationship with Amgen Inc that includes: speaking and lecture fees. JS reports a relationship with AbbVie Inc that includes: speaking and lecture fees. JS a relationship with Pfizer Inc that includes: speaking and lecture fees. JS reports a relationship with Mundipharma International Limited that includes: speaking and lecture fees. JS reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. JS reports a relationship with Baxter Health that includes: speaking and lecture fees. JS reports a relationship with Becton Dickinson and Company that includes: speaking and lecture fees. JS reports a relationship with Juniper Pharmaceuticals Inc that includes: board membership. JS reports a relationship with Antengene Corporation Limited that includes: board membership. DJMR reports a relationship with Sandoz Inc that includes: speaking and lecture fees. DJT reports a relationship with National Health and Medical Research Council that includes: funding grants. DWJ reports a relationship with Baxter Health that includes: speaking and lecture fees. JSho reports a relationship with Astex Pharmaceuticals US Corporate and Development Headquarters that includes: funding grants. JSho reports a relationship with Astellas Pharma Inc that includes: consulting or advisory. JSho reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: consulting or advisory. JSho reports a relationship with Novartis Pharmaceuticals Corporation that includes: consulting or advisory and speaking and lecture fees. JSho reports a relationship with Pfizer Inc that includes: consulting or advisory. JSho reports a relationship with Mundipharma International Limited that includes: speaking and lecture fees. JSho reports a relationship with BeiGene that includes: board membership. JSho reports a relationship with Bristol Myers Squibb Co that includes: board membership. MJJ reports a relationship with National Health and Medical Research Council that includes: funding grants. MJJ reports a relationship with Amgen Inc that includes: funding grants and speaking and lecture fees. MJJ reports a relationship with Baxter Health that includes: board membership and funding grants. MJJ reports a relationship with CSL Behring LLC that includes: board membership and funding grants. MJJ reports a relationship with Eli Lilly and Company that includes: funding grants. MJJ reports a relationship with Gambro Dialysis Machines GmbH that includes: funding grants. MJJ reports a relationship with Merck Sharp & Dohme UK Ltd that includes: board membership and funding grants. MJJ reports a relationship with Medscape Education that includes: speaking and lecture fees. MJJ reports a relationship with CESAS Medical Ltd that includes: speaking and lecture fees. MJJ reports a relationship with Medcon International PACE CE that includes: speaking and lecture fees. MJJ reports a relationship with Boehringer Ingelheim Corp USA that includes: board membership and speaking and lecture fees. MJJ reports a relationship with Janssen Pharmaceuticals Inc that includes: board membership and speaking and lecture fees. MJJ reports a relationship with Novo Nordisk Inc that includes: speaking and lecture fees. MJJ reports a relationship with Roche that includes: speaking and lecture fees. MJJ reports a relationship with Vifor Pharma Switzerland SA that includes: board membership and speaking and lecture fees. MJJ reports a relationship with Akebia Therapeutics Inc that includes: board membership. MJJ reports a relationship with Bayer Pharma AG that includes: board membership. MJJ reports a relationship with Occuryx that includes: board membership. MJJ reports a relationship with Chinook Therapeutics Inc that includes: board membership. PC reports a relationship with Pfizer that includes: funding grants. PC reports a relationship with Gilead Sciences Inc that includes: funding grants, speaking and lecture fees, and travel reimbursement. RLW reports a relationship with Cancer Institute NSW that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Aligning kidney function assessment in patients with cancer to global practices in internal medicine

Affiliations

Aligning kidney function assessment in patients with cancer to global practices in internal medicine

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous