Nephrotoxicity after PRRT — still a serious clinical problem? Renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATATE and 90Y/177Lu-DOTATATE

Abstract

Introduction: The kidneys play an essential role in PRRT. The infusion of amino acids could reduce uptake in the kidney of radiolabelled peptides. The purpose of this study was to determine the extent of kidney damage post PRRT.
Material and methods: 53 patients, with disseminated neuroendocrine tumours (NET), received 3–5 cycles of up to a maximum 7.4 GBq/m2 calculated dose of 90Y-DOTATATE (n = 25) and 90Y/177Lu-DOTATATE (n = 28). Creatinine levels were measured and glomerular filtration rates (GFR) were calculated. A mixed amino acid infusion was used for nephroprotection.
Results: Patients treated with 90Y-DOTATATE had a mean creatinine level of 0.77 ± 0.19 mg/dL and a mean GFR (mL/min/1.73 m2) of 103.6 ± 30.8. Patients treated with 90Y/177Lu-DOTATATE had a mean creatinine level of 0.92 ± 0.33 mg/dL and a mean GFR of 84.7 ± 26.3. In the follow up, among patients treated with 90Y-DOTATATE and 90Y/177Lu-DOTATATE, the mean GFR level at 12 months was 101.2 ± 31.3 v. 83.9 ± 25.2, at 24 months 80.2 ± 32.7 v. 77.2 ± 31.1, at 36 months 78.9 ± 42.1 v. 67.5 ± 9.7, and 48 months 59.7 ± 15.2 v. 72.6 ± 11.2. The mean yearly decrease in GFR was 4.5 mL in all treated patients; for patients treated with 90Y-DOTATATE and 90Y/177Lu-DOTATATE it was 6.8 v. 3.0, respectively.
Conclusions: 90Y/177Lu-DOTATATE treatment induced statistically significantly less change in kidney function compared to 90Y-DOTATATE.