Comparative assessment of KDIGO and CTCAE criteria for detecting renal function deterioration after peptide receptor radionuclide therapy
6 affiliations
- 1Department of Nuclear Medicine, LMU University Hospital, LMU Medizin, LMU Munich, Marchioninistr. 15, Munich, 81377 Germany
- 2Interfaculty Centre for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU University Hospital, LMU Medizin, LMU Munich, Munich, Germany
- 3Department of Internal Medicine IV, LMU University Hospital, LMU Medizin, LMU Munich, Munich, Germany
- 4ENETS Certified Center of Excellence), Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET- KUM, LMU University Hospital, LMU Medizin, LMU Munich, Munich, Germany
- 5German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- 6Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
Abstract
Purpose: Renal toxicity after peptide receptor radionuclide therapy (PRRT) is commonly assessed using Common Terminology Criteria for Adverse Events (CTCAE), whereas nephrological classification relies on Kidney Disease: Improving Global Outcomes (KDIGO)-based renal function categories. We compared CTCAE- and KDIGO-derived eGFRcr-based definitions of renal function deterioration after PRRT and evaluated their predictive value for subsequent long-term renal outcome.
Methods: 149 gastroenteropancreatic neuroendocrine tumor patients scheduled for PRRT with renal follow-up for at least 12 months after treatment were included. Kidney function was assessed at baseline (BL), after the last cycle (LC) and last available follow-up (FU). Analyzing the time interval from BL to LC, estimated glomerular filtration rate (eGFRcr)-based KDIGO and CTCAE classifications along with risk factors for recategorization were compared. Clinically relevant KDIGO worsening was defined according to KDIGO 2012 (eGFRcr category worsening with an additional eGFRcr decline ≥ 25%).
Results: Median eGFRcr declined from 87 to 68 mL/min/1.73 m² over a median follow-up of 2.2 years (p < 0.0001). From BL to FU, clinically relevant KDIGO worsening was substantially discordant from CTCAE eGFRcr grading (KDIGO-/CTCAE+: 21 vs. KDIGO+/CTCAE-: 2; p < 0.0001). In multivariable analysis, age (p = 0.0125) and cumulative activity (p = 0.0205) were associated with clinically relevant KDIGO worsening (CTCAE eGFRcr worsening: age, p < 0.0209). Early CTCAE eGFRcr worsening during BL to LC predicted subsequent annualized eGFR decline until further FU (β − 6.82; 95% CI − 10.06 to − 3.57; p < 0.0001). Both clinically relevant KDIGO eGFRcr worsening and absolute eGFRcr at LC, however, failed to reach significance for long-term outcome prediction of renal function (p > 0.05, each).
Conclusion: For evaluation of renal safety under PRRT, clinically relevant KDIGO deterioration and CTCAE grading are not interchangeable. Clinically relevant KDIGO-derived eGFRcr worsening represents a stricter filtration-based endpoint, whereas early CTCAE eGFRcr worsening may help identify patients requiring closer post-treatment renal surveillance. Prospective studies integrating serial filtration markers, urine biomarkers, measured GFR, and individualized kidney dosimetry are warranted, especially in light of current ongoing trials investigating PRRT being moved to an earlier stage in the treatment course.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08126-4.
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BibTeX
@article{siegmund2026comparative,
title = {{Comparative assessment of KDIGO and CTCAE criteria for detecting renal function deterioration after peptide receptor radionuclide therapy}},
author = {Sophie C. Siegmund and Mohamed Salem and Elma Dema and Liam Widjaja and Franz Josef Gildehaus and Christine Spitzweg and Christoph J. Auernhammer and Matthias Brendel and Rudolf A. Werner},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
month = aug,
doi = {10.1007/s00259-026-08126-4},
url = {https://doi.org/10.1007/s00259-026-08126-4},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative assessment of KDIGO and CTCAE criteria for detecting renal function deterioration after peptide receptor radionuclide therapy
AU - Sophie C. Siegmund
AU - Mohamed Salem
AU - Elma Dema
AU - Liam Widjaja
AU - Franz Josef Gildehaus
AU - Christine Spitzweg
AU - Christoph J. Auernhammer
AU - Matthias Brendel
AU - Rudolf A. Werner
PY - 2026
DA - 2026/08/12
JO - European Journal of Nuclear Medicine and Molecular Imaging
DO - 10.1007/s00259-026-08126-4
UR - https://doi.org/10.1007/s00259-026-08126-4
AB - Purpose: Renal toxicity after peptide receptor radionuclide therapy (PRRT) is commonly assessed using Common Terminology Criteria for Adverse Events (CTCAE), whereas nephrological classification relies on Kidney Disease: Improving Global Outcomes (KDIGO)-based renal function categories. We compared CTCAE- and KDIGO-derived eGFRcr-based definitions of renal function deterioration after PRRT and evaluated their predictive value for subsequent long-term renal outcome. Methods: 149 gastroenteropancreatic neuroendocrine tumor patients scheduled for PRRT with renal follow-up for at least 12 months after treatment were included. Kidney function was assessed at baseline (BL), after the last cycle (LC) and last available follow-up (FU). Analyzing the time interval from BL to LC, estimated glomerular filtration rate (eGFRcr)-based KDIGO and CTCAE classifications along with risk factors for recategorization were compared. Clinically relevant KDIGO worsening was defined according to KDIGO 2012 (eGFRcr category worsening with an additional eGFRcr decline ≥ 25%). Results: Median eGFRcr declined from 87 to 68 mL/min/1.73 m² over a median follow-up of 2.2 years (p < 0.0001). From BL to FU, clinically relevant KDIGO worsening was substantially discordant from CTCAE eGFRcr grading (KDIGO-/CTCAE+: 21 vs. KDIGO+/CTCAE-: 2; p < 0.0001). In multivariable analysis, age (p = 0.0125) and cumulative activity (p = 0.0205) were associated with clinically relevant KDIGO worsening (CTCAE eGFRcr worsening: age, p < 0.0209). Early CTCAE eGFRcr worsening during BL to LC predicted subsequent annualized eGFR decline until further FU (β − 6.82; 95% CI − 10.06 to − 3.57; p < 0.0001). Both clinically relevant KDIGO eGFRcr worsening and absolute eGFRcr at LC, however, failed to reach significance for long-term outcome prediction of renal function (p > 0.05, each). Conclusion: For evaluation of renal safety under PRRT, clinically relevant KDIGO deterioration and CTCAE grading are not interchangeable. Clinically relevant KDIGO-derived eGFRcr worsening represents a stricter filtration-based endpoint, whereas early CTCAE eGFRcr worsening may help identify patients requiring closer post-treatment renal surveillance. Prospective studies integrating serial filtration markers, urine biomarkers, measured GFR, and individualized kidney dosimetry are warranted, especially in light of current ongoing trials investigating PRRT being moved to an earlier stage in the treatment course. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08126-4.
SN - 1619-7070
SN - 1619-7089
ER -