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Low serum creatinine as a prognostic marker in advanced cancer
  1. Koji Amano1,2,
  2. Vickie Baracos3,
  3. Satomi Okamura4,
  4. Tomomi Yamada4,
  5. Isseki Maeda5,
  6. Hiroyuki Otani6,
  7. Hiroto Ishiki7,
  8. Tomofumi Miura8,
  9. Jun Hamano9,
  10. Yutaka Hatano10,
  11. Tatsuya Morita11 and
  12. Masanori Mori11
  13. East-Asian collaborative
  1. 1Palliative and Supportive Care Center, Osaka University Hospital, Suita, Japan
  2. 2Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Osaka, Japan
  3. 3Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
  4. 4Department of Medical Innovation, Osaka University Hospital, Suita, Japan
  5. 5Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
  6. 6Department of Palliative and Supportive Care, St. Mary’s Hospital, Kurume, Japan
  7. 7Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
  8. 8Department of Palliative Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
  9. 9Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
  10. 10Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
  11. 11Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka, Japan
  1. Correspondence to Dr Koji Amano, Osaka University Hospital, Suita, Osaka, Japan; kojiamano4813{at}


Objectives To evaluate whether low serum creatinine levels are associated with poor outcomes in patients with advanced cancer.

Methods This is a secondary analysis of a prospective cohort study. Patients were divided into three groups according to their baseline serum creatinine levels. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests, and by conducting univariate and multivariate Cox regression analyses.

Results 809 males were divided: male-low group (n=192), male-normal group (n=403) and male-high group (n=214). 808 females were divided: female-low group (n=239), female-normal group (n=389) and female-high group (n=180). Significant differences were observed in survival rates between the high and normal groups in the males and females (both log-rank p<0.001). Significantly higher risks of mortality were observed in the Cox proportional hazard model for the high group than for the normal group in both sexes (adjusted HR 1.292, 95% CI 1.082 to 1.542; adjusted HR 1.316, 95% CI 1.094 to 1.583, respectively). High serum creatinine was associated with shorter survival than normal creatinine, while low serum creatinine was not.

Conclusions Low serum creatinine levels did not have prognostic abilities in this population.

  • Cancer
  • Prognosis

Data availability statement

The datasets generated and analysed during this study are not publicly available because sharing is not explicitly covered by patient consent.

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Data availability statement

The datasets generated and analysed during this study are not publicly available because sharing is not explicitly covered by patient consent.

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  • Contributors Conceptualisation: KA; methodology: KA and IM; software: SO and TY validation: KA, SO and TY; formal analysis: SO and TY; investigation: KA and VB resources: KA, IM, HO, HI, TM, JH, YH and MM: data curation, KA, IM, HO, HI, TM, JH, YH and MM: writing—original draft preparation, KA writing—review and editing: VB and SO visualisation: KA, SO and TY; supervision: TM; project administration: TM and MM funding acquisition: TM. All authors have read and agreed to the published version of the manuscript.

  • Funding This study was supported in part by a Grant-in-Aid from the Japan Hospice Palliative Care Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.