GFR estimation in lenalidomide treatment of multiple myeloma patients: a prospective cohort study

Andrea Schmidts, Julian Grünewald, Martina Kleber, Evangelos Terpos, Gabriele Ihorst, Heike Reinhardt, Gerd Walz, Ralph Wäsch, Monika Engelhardt, Stefan Zschiedrich

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The estimated glomerular filtration rate (eGFR) is clinically used to approximate renal function and adapt drug dosage. Multiple myeloma is a hematological disease; its prognosis is largely influenced by renal function. We evaluated two commonly used GFR estimations, CKD-EPI and MDRD (CKD Epidemiology Collaboration; Modification of Diet in Renal Disease) in myeloma patients undergoing treatment with lenalidomide, a renally excreted immunomodulatory drug. Methods: We prospectively studied 130 myeloma patients receiving lenalidomide treatment at our institution. At baseline and after 3 months, GFR estimations were performed based on the CKD-EPI and MDRD equations. We compared eGFR-dependent CKD staging and lenalidomide dosage assignments. Results: Initially, most patients were classified as CKD stage I/II, using both equations. Comparison of baseline renal function via CKD-EPI and MDRD induced concordance of CKD staging in 83% of patients, while CKD-EPI improved CKD staging in 16% of patients (p = 0.11). CKD-EPI assigned 3% of patients to higher lenalidomide dosing as opposed to MDRD. Both equations showed improved eGFR after 3 months of lenalidomide treatment. Conclusions: In our multiple myeloma patient cohort, CKD-EPI and MDRD led to similar CKD staging with minor differences in lenalidomide dosage assignment. Consistent with previous studies, eGFR improved under lenalidomide treatment. To standardize GFR estimation in myeloma patients, we suggest using the CKD-EPI equation.

Original languageEnglish
Pages (from-to)199-206
Number of pages8
JournalClinical and Experimental Nephrology
Volume23
Issue number2
DOIs
StatePublished - 15 Feb 2019
Externally publishedYes

Keywords

  • Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI)
  • eGFR
  • Lenalidomide
  • Modification of diet in renal disease (MDRD)
  • Multiple myeloma

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