Renal insufficiency, in addition to being a global health issue, is also one of the most important comorbidities for our cancer patients, both in terms of frequency and in terms of related complications.
Dr. Simonelli, what are the dangers associated with the condition of kidney failure in a cancer patient?
For cancer patients, renal failure represents an unfavorable prognostic factor, causing complications that involve all the apparatus of our organism and often disabling consequences. Due to the excretion function of the kidney, a kidney malfunction can also compromise the feasibility of anticancer treatments, leading to an increase in all toxicities. It is enough to think that about half of the drugs administered are eliminated through a renal route and many drugs have an intrinsic nephrotoxicity. The new biological drugs can also cause kidney damage, because they are not selective and act against normally expressed molecular targets also at the kidney level.
What can I do to limit the dangers?
Historically, we have evaluated the renal function of our patients using serum creatinine values, which in fact has important limitations as an index of renal function. There are mathematical formulas that combine variously the values of serum creatinine with the characteristics of sex, age, body surface and race, giving us a reliable estimate of the glomerular filtrate, which represents the most accurate and reliable index of renal function.
Recently, a large French observational study demonstrated that, using glomerular filtrate estimation, the real prevalence of renal failure in cancer patients was more than 50%.
For these reasons, before administering our pharmacological treatments, we must calculate the renal function of each patient using these formulas, apply all the renal damage prevention strategies available to us, and reduce doses according to the guidelines.
Is paying more attention to this problem enough?
The cancer patient is increasingly presenting with multiple comorbidities, which we must take into account in the overall management of its treatment. It is therefore essential to collaborate with the various specialists who work together in multidisciplinary teams, in order to assess the patient in his complexity, minimizing the risks and tensions of anticancer pharmacological treatments and maximizing their effectiveness.
