Medication-related adverse events in patients with cancer and discrepancies in cystatin C- versus creatinine-based eGFR

Figures

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  Figure 1.. Patient flow Patient flow. Exposure to each medication was determined by an active prescription within 90 days of the baseline date. *Shows the analyzed sample for each medication. Abbreviations: eGFRCRE = creatinine-based estimated glomerular filtration rate, eGFRCYS = cystatin c-based estimated glomerular filtration rate.

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  Figure 2.. Predictors of eGFR discrepancy Forrest plot showing adjusted odds ratios. Logistic regression models were used to estimate the association between baseline characteristics and the eGFR discrepancy (eGFRCYS > 30% lower than eGFRCRE) in patients with cancer. The unadjusted and adjusted models are also shown in Supplemental Table 2. Abbreviations: eGFRCRE-CYS = estimated Glomerular Filtration Rate calculated using the 2021 race-free combined serum creatinine and cystatin C equation

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  Figure 3.. Rate of eGFR discrepancy by albumin and hemoglobin levels eGFR discrepancy defined by eGFRCYS > 30% lower than eGFRCRE shown with light blue bars, and severe eGFR discrepancy (eGFRCYS > 50% lower than eGFRCRE and eGFRCYS < 30mL/min/1.73m2) shown with dark blue bars become more common in patients with worsening hypoalbuminemia (3A) and anemia (3B).

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  Figure 4.. Rate of supratherapeutic vancomycin levels and trimethoprim-sulfamethoxazole-related hyperkalemia in patients with eGFR discrepancy Figure 4A. Highest trough vancomycin levels obtained within 30 days of starting vancomycin in patients with eGFR discrepancy (eGFRCYS more than 30% lower than eGFRCRE), severe eGFR discrepancy (eGFRCYS more than 50% lower than eGFRCRE and eGFRCYS < 30mL/min/1.73m2), and the reference group. We excluded any vancomycin level obtained less than 6 hours after the last administered vancomycin dose. Figure 4B. Rate of Grade 2 or 3 hyperkalemia in patients receiving trimethoprim-sulfamethoxazole.

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  Figure 5.. Rate of baclofen toxicity and digoxin toxicity in patients with eGFR discrepancy Figure 5A. Rate of baclofen toxicity in patients with eGFR discrepancy, severe eGFR, discrepancy and the reference group. Figure 5B. Rate of supratherapeutic digoxin level defined by >2.0μg/dL. Both cases of clinical digoxin toxicity occurred in patients with severe eGFR discrepancy (eGFRCYS more than 50% lower than eGFRCRE and eGFRCYS < 30mL/min/1.73m2). There were no cases of supratherapeutic digoxin levels or digoxin toxicity in the reference group.

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  Figure 6.. Kaplan-Meier curve of 30-day survival Survival analysis using Kaplan Meier method comparing 30-day survival between reference group and those who had eGFR discrepancy. Unadjusted and adjusted model is shown in Supplemental Table 7.