To see all protocols that comply with the WHO Essential Medicine List 

International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction

Draft Anticancer Drug Dosing In Kidney Dysfunction (ADDIKD) guideline

The consultation period for the guideline has now closed. The final guideline will be published and available shortly.
If you have any questions regarding, please contact feedback@eviq.org.au 

 

Aim of the guideline 

Anticancer drug dosing recommendations in kidney dysfunction are often empirical, dependent on kidney function calculations based on non-standardised creatinine assays and lack applicability to globally accepted kidney dysfunction classifications.

This guideline aims to be a supportive decision-making tool by providing an accepted practical, transparent and standardised approach for the management of anticancer drug dosing in kidney dysfunction based on current evidence and clinical consensus. The final guideline will include recommendations for 59 anticancer drugs.

Guideline development

The working party includes multidisciplinary experts in oncology, haematology, nephrology, pharmacology and geriatrics, with participation from Kidney Disease Improving Global Outcomes (KDIGO), International Society of Geriatric Oncology, British Oncology Pharmacy Association, International Society of Oncology Pharmacy Practitioners, Cancer and the Kidney International Network, National Cancer Institute’s Organ Dysfunction Working Group.

Implementation into eviQ protocols 

The implementation phase into eviQ is a significant undertaking with 700+ protocols and content across the eviQ website to be updated. It requires significant clinical input to ensure rigor and accuracy so that the information is correct and safe to follow.

eviQ is slowing down the ADDIKD implementation project to ensure this next phase is executed successfully. For this reason, adaptation of ADDIKD into eviQ protocols  will NOT be occurring from August 2022 as previously advised.  

As priority interim measures, to occur soon after guideline is published: 

  • a link to the published ADDIKD guideline will be available in every eviQ protocol, and  
  • new eviQ calculators to support the guideline recommendations will also be available on the eviQ website: 
    • standalone eGFR calculator with BSA adjustment 
    • standalone carboplatin dose calculator.

We will continue to provide updates and communication via our dedicated newsletter and this webpage.  

 

Rapid learning to understand more about the ADDIKD Guideline 

This new rapid learning module has been developed to help you understand the purpose of the ADDIKD guideline, methods of assessing kidney function in cancer patients, why eGFR (via CKD-EPI) is the preferred method of estimating kidney function, and kidney function categories for dosing and monitoring. The module should take less than 15 minutes to complete. Have a go and share with your colleagues!

 

Download the ADDIKD flyer for concise guideline information and QR code for the mini-quiz to share with your colleagues 

Do you know the best method of assessing kidney function in your cancer patients? 

There are many available methods to assess kidney function in clinical practice, but do you know the best method?

Measured glomerular filtration rate (i.e. direct measurement via iohexol, iothalamate, 51Cr-EDTA or 99Tc-DTPA) is the gold standard in determining kidney function and informing drug dosing decisions, however it is not always practically available.1,2 In its absence estimated glomerular filtration rate calculated via the Chronic Kidney Disease – Epidemiology Collaboration (CKD-EPI) equation (eGFR CKD-EPI), provides a suitable alternative in most clinical scenarios. eGFR CKD-EPI is routinely reported in laboratory blood test reports and is more precise than other methods for estimating kidney function.  

If you are having problems access the app via the QR code above you can also access via this link: https://link.edapp.com/3txVb6YAGkb

 

Professor David Johnson talks about the guideline

Listen to Professor David Johnson, Director of the Metro South Integrated Nephrology and Transplant Service and Medical Director of the Queensland Kidney Transplant Service at Princess Alexandra Hospital, Brisbane, discuss the reasons why eGFR CKD-EPI is the preferred method to assess kidney function in cancer patients.

 

Following publication of the guideline in 2022, eGFRCKD-EPI will be the preferred method of assessing kidney function throughout the eviQ website including for the guidance of anticancer drug dosing in kidney dysfunction, for the following reasons:3-9 

 

Consensus recommendations on a standardised approach to assessing kidney function in cancer patients 

Three draft recommendations for a standardised approach to assessing kidney function in cancer patients and subsequent dose adjustments in kidney dysfunction achieved consensus at a national workshop on 14 December 2020. This workshop involved 56 participants from around the world including leading experts in nephrology, oncology, haematology, clinical pharmacology, geriatrics and chemical pathology, as well as key national stakeholders representing medical groups and regulatory bodies.

 

Why is eviQ standardising the dose modifications section within treatment protocols to the recommendations from the ADDIKD guideline?  

Currently, for anticancer drug dosing there are: 

  • inconsistencies in assessing and defining kidney function
  • a lack of definitive guidance on which kidney function estimate to use
  • large variations in dosing adjustment approaches 
  • limited evidence on older drugs in kidney dysfunction.

With over 75% of eviQ users either frequently or always use eviQ’s dose modification recommendations for kidney dysfunction to inform dose adjustments, it is important that this information in the eviQ treatment protocols be practical, evidence based and safe. The ADDIKD guideline was specifically developed for this purpose.

 

Senior Cancer Pharmacist Jim Siderov talks about the importance of evidence based guidance and a uniform approach

Listen to Jim Siderov AM, senior cancer pharmacist at the Austin Hospital, Melbourne talk about the importance of evidence based guidance to assist cancer practitioners in the dosing of anticancer drugs in kidney dysfunction. He also highlights how a uniformed approach to dose modification promotes safety and reduces variability in care.

 

 

References:

  1. Stefani M, Singer RF, Roberts DM. How to adjust drug doses in chronic kidney disease. Aust Prescr 2019;42(5):163-167 
  2. Malyszko J, Lee MW, Capasso G, et al. How to assess kidney function in oncology patients. Kidney Int 2020;97(5):894-903
  3. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150(9):604-612
  4. Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) Creatinine Equation: More accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 2010;55(4):622-627 
  5. Maple-Brown LJ, Ekinci EI, Hughes JT, et al. Performance of formulas for estimating glomerular filtration rate in Indigenous Australians with and without Type 2 diabetes: the eGFR Study. Diabet Med 2014;31(7):829-838 
  6. Rhee J, Kwon JM, Han SH, et al. Cockcroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration equations for estimating glomerular filtration rates in cancer patients receiving cisplatin-based chemotherapy. Kidney Res Clin Pract 2017;36(4):342-348
  7. Johnson DW, Jones GRD, Mathew TH, et al. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations. Med J Aust 2012;197(4):222-223 
  8. Johnson D, Jones G, Mathew T, et al. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: revised recommendations. Med J Aust 2007;187:459-463 
  9. Kidney Disease Improving Global Outcomes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3(1)