nancy and treatment may cause kidney injury and subsequent CKD. To date, there has been lack of guidance to standardize approaches to GFR estimation in the cancer population. In this two-part statement from the American Society of Onco-Nephrology, we present key messages for estimation of GFR in patients with cancer, including the choice of GFR estimating equation, use of race and body surface-area (BSA)-adjustment, and anticancer drug dose-adjustment in the setting of CKD. These key messages are based on a systematic review of studies assessing GFR estimating equations using serum creatinine and cystatin C in patients with cancer, against a measured GFR comparator. The preponderance of current data involving validated GFR estimating equations involves the CKD-EPI equations, with 2,508 patients in whom CKD-EPI using serum creatinine and cystatin C was assessed (8 studies) and 15,349 in whom CKD-EPI with serum creatinine was assessed (22 studies). The former may have improved performance metrics and be less susceptible to shortfalls of eGFR using serum creatinine alone. Since included studies were moderate quality or lower, the ASON Position Committee rated the certainty of evidence as low. Additional studies are needed to assess the accuracy of other validated eGFR equations in patients with cancer. Given the importance of accurate and timely eGFR assessment we advocate for the use of validated GFR estimating equations incorporating both serum creatinine and cystatin C in patients with cancer. Measurement of GFR via exogenous filtration markers should be considered in patients with cancer for whom eGFR results in borderline eligibility for therapies or clinical trials. Accurate assessment of glomerular filtration rate (GFR) is crucial to guiding drug eligibility, dosing of systemic therapy, and minimizing the risks of both undertreatment and toxicity in patients with cancer. Up to 32% of cancer patients have baseline chronic kidney disease (CKD), and both malignancy and treatment may cause kidney injury and subsequent CKD. To date, there has been lack of guidance to standardize approaches to GFR estimation in the cancer population. In this two-part statement from the American Society of Onco-Nephrology, we present key messages for estimation of GFR in patients with cancer, including the choice of GFR estimating equation, use of race and body surface-area (BSA)-adjustment, and anticancer drug dose-adjustment in the setting of CKD. These key messages are based on a systematic review of studies assessing GFR estimating equations using serum creatinine and cystatin C in patients with cancer, against a measured GFR comparator. The preponderance of current data involving validated GFR estimating equations involves the CKD-EPI equations, with 2,508 patients in whom CKD-EPI using serum creatinine and cystatin C was assessed (8 studies) and 15,349 in whom CKD-EPI with serum creatinine was assessed (22 studies). The former may have improved performance metrics and be less susceptible to shortfalls of eGFR using serum creatinine alone. Since included studies were moderate quality or lower, the ASON Position Committee rated the certainty of evidence as low. Additional studies are needed to assess the accuracy of other validated eGFR equations in patients with cancer. Given the importance of accurate and timely eGFR assessment we advocate for the use of validated GFR estimating equations incorporating both serum creatinine and cystatin C in patients with cancer. Measurement of GFR via exogenous filtration markers should be considered in patients with cancer for whom eGFR results in borderline eligibility for therapies or clinical trials. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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癌症患者肾小球滤过率的评估：美国肿瘤肾病学会的声明


南希和治疗可能会导致肾损伤和随后的 CKD。迄今为止，尚缺乏癌症人群 GFR 估计标准化方法的指导。在美国肿瘤肾病学会的这份由两部分组成的声明中，我们提出了估计癌症患者 GFR 的关键信息，包括 GFR 估计方程的选择、种族和体表面积 (BSA) 调整的使用、以及 CKD 背景下的抗癌药物剂量调整。这些关键信息基于对使用癌症患者血清肌酐和胱抑素 C 与测量的 GFR 比较器评估 GFR 估计方程的研究的系统回顾。目前涉及经过验证的 GFR 估计方程的数据主要涉及 CKD-EPI 方程，其中对 2,508 名患者使用血清肌酐和胱抑素 C 进行了 CKD-EPI 评估（8 项研究），对 15,349 名患者使用血清肌酐进行了 CKD-EPI 评估（ 22项研究）。前者可能会改善性能指标，并且单独使用血清肌酐时不易受到 eGFR 不足的影响。由于纳入的研究质量中等或较低，ASON 立场委员会将证据的质量评为低。需要进行更多研究来评估其他经过验证的 eGFR 方程在癌症患者中的准确性。鉴于准确、及时的 eGFR 评估的重要性，我们主张在癌症患者中使用经过验证的 GFR 估计方程，其中包含血清肌酐和胱抑素 C。对于 eGFR 导致治疗或临床试验的临界资格的癌症患者，应考虑通过外源性滤过标记物测量 GFR。 准确评估肾小球滤过率 (GFR) 对于指导药物资格、全身治疗的剂量以及最大限度地降低癌症患者治疗不足和毒性的风险至关重要。高达 32% 的癌症患者基线患有慢性肾病 (CKD)，恶性肿瘤和治疗都可能导致肾损伤和随后的 CKD。迄今为止，尚缺乏癌症人群 GFR 估计标准化方法的指导。在美国肿瘤肾病学会的这份由两部分组成的声明中，我们提出了估计癌症患者 GFR 的关键信息，包括 GFR 估计方程的选择、种族和体表面积 (BSA) 调整的使用、以及 CKD 背景下的抗癌药物剂量调整。这些关键信息基于对使用癌症患者血清肌酐和胱抑素 C 与测量的 GFR 比较器评估 GFR 估计方程的研究的系统回顾。目前涉及经过验证的 GFR 估计方程的数据主要涉及 CKD-EPI 方程，其中对 2,508 名患者使用血清肌酐和胱抑素 C 进行了 CKD-EPI 评估（8 项研究），对 15,349 名患者使用血清肌酐进行了 CKD-EPI 评估（ 22项研究）。前者可能会改善性能指标，并且单独使用血清肌酐时不易受到 eGFR 不足的影响。由于纳入的研究质量中等或较低，ASON 立场委员会将证据的质量评为低。需要进行更多研究来评估其他经过验证的 eGFR 方程在癌症患者中的准确性。 鉴于准确、及时的 eGFR 评估的重要性，我们主张在癌症患者中使用经过验证的 GFR 估计方程，其中包含血清肌酐和胱抑素 C。对于 eGFR 导致治疗或临床试验的临界资格的癌症患者，应考虑通过外源性滤过标记物测量 GFR。版权所有 © 2024 美国肾脏病学会...