The outcome of cancer patients (pts) is influenced by a variety of coexisting conditions. Renal impairment has been shown to be one major risk factor in a number of diseases, such as myocardial infarction (MI), and is associated with dismal clinical outcome. However the influence of milder degrees of renal disease is less well defined, especially not yet in pts with solid tumors (ST) or hematological malignancies (HM). Between 8/2004-3/2005, we analyzed 167 ST and HM pts. Of 108 male and 59 female pts, 94 had ST and 73 HM. Their median age was 59 years (range; 18–91). Local vs. advanced (=metastatic) disease was present in 36 vs. 131 pts, respectively. Disease specific parameters, such as tumor diagnoses, sex, age, local vs. advanced disease, performance status (Karnofsky index=KI), number of concurrent diagnoses, cardiovascular risk factors such as body-mass index (BMI), presence of stroke or transient ischemic attack (TIA) and comorbidities (Satariano index=SI) were determined, also serum creatinine (creat), cystatin C (cC) and ProBNP (BNP). The glomerular filtration rate (GFR) was estimated by use of the ’Modification of Diet in Renal Disease’ (MDRD) equation (
). The SI included heart diseases, diabetes, cancer, respiratory, gallbladder, and liver deteriorations. Pts were compared within GFR-, cC-, creat- and comorbidity-groups. Despite a median of 3 (range; 0–8) concurrent diagnoses, the KI in all pts was almost normal with a median of 90% (range; 30–100) and the median SI was 1 (range; 0–3). The median MDRD of all pts was 88ml/min/1.73m2 (14–240), and groups with GFR ≥75 (I), 60–74.9 (II), 45–59.9 (III) and <45 (IV) consisted of 105, 26, 23 and 13 pts, respectively. Of note was that pts showing a decreased GFR (<75ml/min/1.73m2) were older, had a significantly higher BMI (p=0.013), increased number of concurrent diagnoses (p=0.0486), and elevated creat- (p<0.0001), cC- (p<0.0001) and BNP-levels (p<0.0001; all Wilcoxon 2-sample tests). GFR - as compared to creat- or cC-levels - demonstrated this correlation best. Renal impairment (determined by elevated creat levels) was associated with increased odds ratios of 1.4 (95%CI 0.5–4.2), 1.5 (95%CI 0.7–3.2), 2.3 (95%CI 0.1–38.3) and 7.2 (95%CI 1.8–28.3) for comorbidities, such as diabetes, hypertension, apoplex and MI, respectively, which for the latter proved to be of statistical significance (p=0.0044). These observations indicate that grouping pts according to their renal function may be one way of determining specific risk groups. Comparing creat-, cC- and GFR-levels, the latter seems most valuable for determining mild or moderate renal impairment. Especially prior MI and elevated BNP levels will be studied further, since both seem closely associated with risks for renal impairment. Ongoing studies will determine, if mild renal disease is also a risk factor for adverse clinical outcome in ST and HM pts.
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