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 utilizes Brochner-Mortensen (1972) first exponential correction and the Haycock (1978) body surface area correction in accordance with the BNMS guidelines. For a 3-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 (meanąSE) 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.
References
1. Fleming JS, Zivanovic MA, Blake GM, Burniston M, Cosgriff PS. Guidelines for the measurement of glomerular filtration rate using plasma sampling. Available at www.bnms.org, 2004.
2. Cosgriff PS. www.nuclearmedicine.org.uk (version 4.6).
Phillips D, Richardson MA, Ardley RG, Chandler ST, Wright D, Gokul S. An audit of GFR calculation methodology across three hospital sites and its impact on chemotherapy dose prescription. British Nuclear Medicine Society Autumn Meeting, Cambridge 2006. Nuclear Medicine Communications, 27(12):1026 (2006).
Mr. Steve Chandler, Darlington Unit, Darlington. Tel: +44 (0)1325-743-347.
Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
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