Possible risk of overestimation of renal function using cystatin C-based eGFR in testicular cancer survivors treated with cisplatin-based chemotherapy

Clin Exp Nephrol. 2018 Jun;22(3):727-734. doi: 10.1007/s10157-017-1474-x. Epub 2017 Sep 25.

Abstract

Background: Chronic kidney disease (CKD) is a major long-term morbidity of testicular cancer (TC) survivors cured by cisplatin-based chemotherapy. We conducted the present study to elucidate the usefulness of cystatin-based estimated glomerular filtration rates (eGFRcys) for diagnosis of CKD compared to creatinine-based eGFR (eGFRcreat) in those patients.

Methods: eGFRcys and eGFRcreat were measured in 53 TC survivors. The 24-h creatinine clearance (CrCl) was measured in 12 TC survivors and 17 CKD patients with medical disease; all of them had eGFRcreat <60 m/min/1.73 m2. Also, urinary beta2-microglobulin and albumin concentrations in spot urine specimens were measured.

Results: The mean eGFRcreat was significantly lower than eGFRcys, at 67.9 and 95.2 ml/min/1.73 m2, respectively (p < 0.05). The prevalence of stage 3-5 CKD differed by GFR estimation methods. It was 47.2% with eGFRcreat and only 7.5% with eGFRcys. There were 21 patients with eGFRcreat <60 ml/min/1.73 m2 and eGFRcys ≥60 ml/min/1.73 m2. In all 12 TC survivors, the eGFRcys values were higher than both eGFRcreat and GFR (24-h CrCl). In contrast, no difference was observed among eGFR values in the 17 patients with CKD due to medical disease. Ten of 21 patients with eGFRcreat <60 ml/min/1.73 m2 and eGFRcys ≥60 ml/min/1.73 m2 showed significant beta2-microglobulinuria: a higher prevalence than that in patients with both eGFRs ≥60 ml/min/1.73 m2. Also, the incidence of microalbuminuria tended to be high in those patients.

Conclusions: The present study suggests that eGFRcys may overestimate renal function in TC survivors cured by cisplatin-based chemotherapy.

Keywords: Chemotherapy; Chronic kidney disease; Cisplatin; Cystatin C; Estimated glomerular filtration rate; Testicular cancer.

MeSH terms

  • Adolescent
  • Adult
  • Albuminuria / epidemiology
  • Antineoplastic Agents / adverse effects*
  • Cisplatin / adverse effects*
  • Creatinine / blood
  • Cystatin C / blood
  • Glomerular Filtration Rate*
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Insufficiency, Chronic / chemically induced*
  • Renal Insufficiency, Chronic / diagnosis*
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / metabolism
  • Testicular Neoplasms / drug therapy
  • Young Adult

Substances

  • Antineoplastic Agents
  • Cystatin C
  • Creatinine
  • Cisplatin