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. 2025 Dec;133(11):1652-1659.
doi: 10.1038/s41416-025-03190-3. Epub 2025 Sep 19.

Accuracy of glomerular filtration rate estimates among patients with cancer

Jennifer S Lees  1   2 , Edouard L Fu  3   4 , Anne-Laure Faucon  4 , Benjamin Mp Elyan  5   6 , Lesley A Inker  7 , Andrew S Levey  7 , Robert J Jones  6   8 , Richard H Wilson  6   8 , Patrick B Mark  5   6 , Juan-Jesus Carrero  4   9
Affiliations

Accuracy of glomerular filtration rate estimates among patients with cancer

Jennifer S Lees et al. Br J Cancer. 2025 Dec.

Abstract

Background: Glomerular filtration rate (GFR) estimation is a key issue in determining cancer treatment eligibility and dosing of treatments with narrow therapeutic index. Yet, little is known about the accuracy of GFR estimation among people with cancer in routine care.

Methods: In a cross-sectional study including 1611 adults with cancer referred for 1837 determinations of measured GFR (mGFR), we assessed the accuracy of estimated GFR based on creatinine (eGFRcr), cystatin C (eGFRcys) and their combination (eGFRcr-cys). Accuracy was reported as percentage of patients with estimated values within 30% of mGFR; bias and precision as the median and interquartile range of eGFR-mGFR, respectively. Dosing accuracy was assessed by calculating expected dose of carboplatin for area under the curve of 5 mg/mL/min using the Calvert formula.

Results: Median age was 68 (IQI 61 to 74) years, 38.5% were female with mean mGFR 75 (SD 30) mL/min; 17% had metastatic disease. Accuracy, bias and precision were best for eGFRcr-cys. Using eGFRcr would recommend an "overdose" of carboplatin in 10-20% of participants: this was 3-4 times less common using eGFRcr-cys.

Conclusion: eGFRcr-cys equations provide the most accurate estimates of mGFR in patients with cancer, with potential to improve dosing accuracy substantially compared to eGFRcr.

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Conflict of interest statement

Competing interests: Outside the submitted work, J.S.L. has received personal consultancy fees from Boehringer Ingelheim and lectureship honoraria from Astra Zeneca. Outside the submitted work, P.B.M. has received honoraria for lectures and advisory boards from AstraZeneca, Vifor, Pharmacosmos, GSK, Bayer and Boehringer Ingelheim and research funding from AstraZeneca and Boehringer Ingelheim. Outside of the submitted work, B.M.P.E. has received honoraria for lectures from AstraZeneca. R.J.J. has personally received honoraria for lectures and consultancy fees from Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Johnson and Johnson, Merck KGaA, Merck Sharp Dohme, Novartis, Pfizer, and Roche, and research funding from Astellas, AstraZeneca, Clovis, Exelixis and Pfizer. L.A.I. reports financial support paid to Tufts Medical Center from the National Institute of Health/National Institute of Diabetes and Digestive and Kidney Diseases, National Kidney Foundation, Chinnocks, Alexion and Astra Zeneca; and participation on the medical advisory council for Alport Foundation and the scientific advisory board for National Kidney Foundation. J.J.C. reports grants paid to Karolinska Institutet from AstraZeneca, Boehringer Ingelheim, CSL Vifor, MSD, Astellas, NovoNordisk, all outside the submitted work; personal fees for lectures or advisory board meetings from Fresenius Kabi, and Laboratorios Columbia, all outside the submitted work. Ethics approval and consent to participate: This study was conducted in accordance with Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) guidance. SCREAM was approved by the Stockholm Ethics Review Board with a waiver of consent (reference 2017/793-31); informed consent was not deemed necessary because all data were deidentified at the Swedish Board of Health and Welfare.

Figures

Fig. 1
Fig. 1. P30, P15 and Bias.
Percentage of patients with estimated values that were within 30% of mGFR (P30) and within 15% of mGFR (P15). Bias was estimated as median difference of eClcr or eGFR minus mGFR. IQR: interquartile range of the bias. mGFR: measured glomerular filtration rate (GFR) by single-point iohexol clearance; eClcr: estimated creatinine clearance; eGFRcr: estimated GFR by creatinine; eGFRcys: estimated GFR by cystatin C; eGFRcr-cys: estimated GFR by creatinine and cystatin C; EKFC: European Kidney Function Consortium. Green: optimal accuracy/small bias; Amber: adequate accuracy/medium bias; Red: inadequate accuracy/large bias.
Fig. 2
Fig. 2. Plots of recommended dosing of carboplatin compared to mGFR.
Density plots showing the difference in recommended dose of carboplatin (to achieve AUC 5 mg/mL/min) calculated by eClcr, eGFRcr, eGFRcys and eGFRcr-cys compared to mGFR. Positive values indicate a higher dose than was calculated by mGFR; negative values represent a lower dose than was calculated by mGFR. CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; EKFC: European Kidney Function Consortium; mGFR: measured glomerular filtration rate (GFR) by single-point iohexol clearance.
Fig. 3
Fig. 3. Subgroups: Proportion of individuals recommended an overdose or underdose of carboplatin compared to dose recommended by mGFR for AUC 5 mg/mL/min of carboplatin.
AUC: area under the curve; BMI: body mass index; eGFRcr: estimated GFR by creatinine; eGFRcys: estimated GFR by cystatin C; eGFRcr-cys: estimated GFR by creatinine and cystatin C; EKFC: European Kidney Function Consortium; mGFR: measured glomerular filtration rate (GFR) by single-point iohexol clearance. Green: ≤5%; Amber: >5-10%; Red: >10%.
See this image and copyright information in PMC

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