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International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction

On behalf of the Cancer Institute NSW, eviQ and the ADDIKD Guideline Working Group, we are pleased to advise the International Guideline for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) is now published and available on the eviQ website.  

 

 

Phase 1: ADDIKD guideline development  - COMPLETE 

Phase 2: Publication of the ADDIKD guideline on the eviQ website - COMPLETE

During this interim phase the eviQ protocols and content have not yet been updated to align with the ADDIKD guideline recommendations. A link to the published ADDIKD guideline is included in every eviQ protocol and two new online calculators have been developed to support users: Estimated Glomerular Filtration Rate (eGFR) Calculator (with the option for BSA-adjusted eGFRCKD-EPI) and a Carboplatin Dose Calculator. 

Phase 3: Implementation of the ADDIKD recommendations into eviQ protocols and content  – COMMENCING  2023 

The implementation of the ADDIKD drug recommendations 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. The timeline for this project is 12-18 months, with updated protocols to be published sequentially during this time period and extensive communication to eviQ users. 


Resources to support you

eviQ have developed several resources to support users in understanding and adopting the ADDIKD guideline recommendations:  

Two new calculators

Estimated Glomerular Filtration Rate (eGFR) Calculator with the option for BSA-adjusted eGFRCKD-EPI

Carboplatin Dose Calculator with options for different AUC and kidney function values

Calculators

 


ADDIKD fact sheet

Summary of the key changes to clinical practice including using eGFRCKD-EPI and carboplatin dosing recommendations. 

factsheet

 


Quick reference tool 

A quick reference tool and summary of the key recommendations for the 59 drugs contained in the ADDIKD guideline.

Quick reference tool

 


Carboplatin case study rapid learning module

Understand the ADDIKD recommendations for the dosing of carboplatin by completing this Carboplatin case study rapid learning. The rapid learning will work through an example using body surface area (BSA) adjusted eGFR in the Calvert formula to calculate a carboplatin dose.

Carboplatin rapid learning module

 


Anticancer drug dosing in kidney dysfunction rapid learning module

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.

Anticancer drug dosing in kidney dysfunction rapid learning module

 


Interactive mini-quiz

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.

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. eGFRCKD-EPI is routinely reported in laboratory blood test reports and is more precise than other methods for estimating kidney function.

Mini-quiz


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 is practical, evidence based and safe. The ADDIKD guideline was specifically developed for this purpose.


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.

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 eGFR CKD-EPI is the preferred method of assessing kidney function

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 

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.

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.

 

Publications and presentations:

Administering Institution Title

Cancer Nurses Society of Australia 2022 Annual Scientific Meeting – June 2022

Concurrent session 14: Hot Topics Getting the dose right in kidney dysfunction: Implementing ADDIKD into eviQ

2022 America Society of Clinical Oncology Annual Meeting I – June 2022

International consensus guideline for anticancer drug dosing in kidney dysfunction (ADDIKD): A standardized approach to assessing kidney function in cancer patients and its application to anticancer drug dosing.

eviQ Cancer Pharmacist Network NSW Virtual Meeting – 25 May 2022

Anticancer Drug Dosing in Kidney Dysfunction 

eviQ Oncology Information System (OIS) webinar – 18 May 2022

Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) guideline implementation into eviQ and potential impact on OIS.

This 60 minute webinar was tailored specifically for Oncology Information System (OIS) managers and those in roles developing and maintaining care plans in OIS at clinical sites.  

Northern Sydney LHD Pharmacy Practice Development Day – 27 April 2022

Getting the dose right in kidney dysfunction – The implications of the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) on clinical pharmacy.

International Society of Oncology Pharmacy Practitioners (ISOPP) 2022 Virtual Symposium – 5 March 2022

Plenary Session: Getting the dose right in kidney dysfunction - the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) (membership login required) 

Basic Sciences of Oncology Course – November 2021

Getting the dose right in kidney dysfunction – the ADDIKD Guideline

Clinical Oncology Society of Australia Annual Scientific Meeting 2021 – 16 November 2021

Concurrent Symposia Stream 1: Medicines Matter. Getting the dose right in kidney dysfunction (membership login required) 

Sydney Cancer Conference – 9 September 2021

Evening Clinical session I Getting the dose right – Development of the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction

Medical Oncology Group of Australia 2021 Annual Scientific Meeting – August 2021

e-Poster: International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction: a standardised approach to assessing kidney function in cancer patients and its application to anticancer drug dosing. 

e-Poster: International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction: anticancer drug specific recommendations on dose adjustment in kidney dysfunction 

Blood 2021 Annual Scientific Meeting – September 2021

e-Poster: International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction: a standardised approach to assessing kidney function in cancer patients and its application to anticancer drug dosing. 

e-Poster: International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction: anticancer drug specific recommendations on dose adjustment in kidney dysfunction 

Clinical Oncology Society of Australia 2018 Annual Scientific Meeting – November 2018

Poster: Getting the dose right - Controversies in renal and hepatic dysfunction.


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)