Cancer and renal insufficiency results of the BIRMA study

BACKGROUND: Half of anticancer drugs are predominantly excreted in urine. Dosage adjustment in renal insufficiency (RI) is, therefore, a crucial issue. Moreover, patients with abnormal renal function are at high risk for drug-induced nephrotoxicity. The Belgian Renal Insufficiency and Anticancer Medications (BIRMA) study investigated the prevalence of RI in cancer patients, and the profile/dosing of anticancer drugs prescribed. METHODS: Primary end point: to estimate the prevalence of abnormal glomerular filtration rate (GFR; estimated with the abbreviated Modification of Diet in Renal Disease formula) and RI in cancer patient. Secondary end point: to describe the profile of anticancer drugs prescribed (dose reduction/nephrotoxicity). Data were collected for patients presenting at one of the seven Belgian BIRMA centres in March 2006. RESULTS: A total of 1218 patients were included. The prevalence of elevated SCR (>= 1.2 mg per 100 ml) was 14.9%, but 64.0% had a GFR < 90 ml min(-1) per 1.73m(2). In all, 78.6% of treated patients (n = 1087) were receiving at least one drug needing dosage adjustment and 78.1% received at least one nephrotoxic drug. In all, 56.5% of RI patients receiving chemotherapy requiring dose reduction in case of RI did not receive dose adjustment. CONCLUSIONS: The RI is highly frequent in cancer patients. In all, 80% of the patients receive potentially nephrotoxic drugs and/or for which dosage must be adjusted in RI. Oncologists should check the appropriate dose of chemotherapeutic drugs in relation to renal function before prescribing. British Journal of Cancer (2010) 103, 1815-1821. doi:10.1038/sj.bjc.6605979 www.bjcancer.com Published online 9 November 2010 (C) 2010 Cancer Research UK