Update on the Assessment of GFR in Patients with Cancer

Accurate assessment of GFR is key in patients with cancer to guide drug eligibility, adjust dosing of systemic therapy, and minimize the risks of undertreatment and systemic toxicity. Several aspects of GFR evaluation in patients with cancer have been unclear, such as the choice of the GFR estimating equation and the overall lack of data on the reliability of new filtration markers, such as cystatin C. This uncertainty has led to concerns that inaccurate GFR estimation may have a large effect on clinical practice and research. Recent data have brought important developments to the field. The new and timely Kidney Disease Improving Global Outcomes 2024 Clinical Practice Guideline for the Evaluation and Management of CKD raised important considerations and provided guidance on key aspects of GFR evaluation in patients with cancer. The guidelines cover valid estimating equations, incorporation of cystatin C in GFR estimation, drawbacks of using race in GFR estimation, and acknowledge that non-GFR determinants of filtration markers may be prominent in patients with cancer, reducing the accuracy of GFR estimating equations, prompting greater utilization of GFR measurement. The aim of this review is to summarize advances in GFR evaluation in patients with cancer considering the new Kidney Disease Improving Global Outcomes guidelines and other recent data.