On Teesside three nuclear medicine departments provide Glomerular Filtration Rate (GFR) measurements for chemotherapy dosage calculation (via the Calvert formula) for patients referred to the Middlesbrough Cancer Centre and its satellite clinics.
The current GFR calculation software, NIRAS (RMPD), uses the Chantler method of Slope-Intercept correction and the Du Bois and Du Bois (1916) formula for body surface area. In response to the publication of BNMS' GFR guidelines [1] and the need to replace dated software the Excel Spreadsheet for Calculation of GFR ("The Cosgriff Spreadsheet") [2] was purchased by all three centres. This software utilises Brochner-Mortensen (1972) first exponential correction and the Haycock (1978) body surface area correction in accordance with the BNMS guidelines.
For a three month period all GFR referrals for chemotherapy prescribing were calculated using the existing NIRAS software and Cosgriff's Spreadsheet (n=134). This allowed a direct comparison of the two methods on measured GFR and their subsequent impact on prescribed chemotherapy dose for this patient population.
The mean percentage difference between the NIRAS and Cosgriff methods was 0.32±0.45 (mean ± S.E.) for absolute GFR but with a range of over 33% (-23.45% to 9.68%). 90% of the audited patient group would receive a + 5% difference in chemotherapy dose, depending on their GFR. This is not regarded as clinically significant.
1. Fleming, J.S., Zivanovic, M.A., Blake, G.M., Burniston, M. and Cosgriff, P.S. (2004) Guidelines for the Measurement of Glomerular Filtration Rate using Plasma Sampling. www.bnms.org
2. www.nuclearmedicine.org.uk (version 4.6); Cosgriff P.S.
Phillips D, Richardson MA, Ardley RG, Chandler ST, Wright D, Gokul S. An audit of glomerular filtration rate calculation across three hospital sites and its impact on chemotherapy dose prescription in oncology. Nuc Med Commun 2006; 27: 1026-1027.
Dionne Philips, Hartlepool Unit. Tel: +44 (0)1429-266-654
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