# Renal dose adjustment of anticancer drugs in reduced kidney function

Source: https://onco.cc/protocols/renal-dose-adjustment-of-anticancer-drugs/  
OnCo record `renal-dose-adjustment-of-anticancer-drugs` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Many cancer drugs leave the body through the kidneys, so if your kidneys work less well the dose may need changing. The newest international guidance (2025) says to measure kidney function the same way the rest of medicine does, with the eGFR on your blood test, to use a more exact kidney test for a few drugs, and to think hard before cutting doses, because a lower dose can work less well.

## Summary

No randomised trials guide anticancer dosing in kidney dysfunction, because reduced kidney function usually excludes people from trials. ADDIKD (2025), an international GRADE-and-consensus guideline from 38 working-group members covering 59 drugs, makes three general recommendations, all clinical consensus and strong: assess kidney function with eGFR by CKD-EPI, except where measured GFR is clinically necessary; use eGFR CKD-EPI to guide dosing of kidney-dependent drugs, preferring measured GFR for initial dosing of carboplatin, cisplatin and high-dose methotrexate (500 mg/m2 or more) and at extremes of body size or muscle mass, amputation or paraplegia; and use the KDIGO CKD categories to step doses. Standardised (1.73 m2) eGFR is used for every drug except carboplatin, where BSA-adjusted eGFR goes into the Calvert formula.

This departs from long practice: product information and older references use Cockcroft-Gault creatinine clearance, and BOPA (2025) still allows measured or calculated methods by local policy. ADDIKD also warns that dose cuts can harm: for cisplatin, several studies found poorer survival in people with eGFR below 60 given reduced doses, and it splits cisplatin into high and low dose at 50 mg/m2. Before deciding, weigh patient factors (hydration, performance status, liver disease, a single kidney), treatment factors (intent, an alternative regimen not dependent on the kidneys, tumour lysis risk, therapeutic drug monitoring, nephrotoxic co-medicines) and access to measured GFR. KDIGO 2024 adds that creatinine-based estimates are unreliable when kidney function is changing, and that medicines should be reviewed at transitions of care.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: renal dosing of chemotherapy; chemotherapy in kidney impairment; anticancer drug dosing in kidney dysfunction; ADDIKD; chemotherapy dose reduction for renal impairment; eGFR vs creatinine clearance for chemotherapy

## Connected records

- protocols: [Anticancer treatment prescribing and pharmacy verification before each cycle](https://onco.cc/protocols/sact-prescribing-and-pharmacy-verification/), [Carboplatin dose calculation by the Calvert formula and kidney function](https://onco.cc/protocols/carboplatin-dose-calculation/), [Hepatic dose adjustment of anticancer drugs in reduced liver function](https://onco.cc/protocols/hepatic-dose-adjustment-of-anticancer-drugs/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Methotrexate](https://onco.cc/drugs/methotrexate/)
- terms: [Pharmacokinetics (PK), half-life and exposure](https://onco.cc/terms/pharmacokinetics/)

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