Renal impairment requiring dose modification: moderate (CrCl 30-50 mL/min) or severe (CrC...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ORGAN-RENAL-IMPAIRED`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Renal impairment requiring dose modification: moderate (CrCl 30-50 mL/min) or severe (CrCl <30 mL/min). Affects renally cleared cytotoxics and targeted agents — cisplatin (severe contraindicated; use carboplatin with Calvert formula), carboplatin (AUC dosing), HD-MTX (contraindicated CrCl <50), HD-cytarabine, cyclophosphamide (25-50% reduction), bleomycin (50% reduction), capecitabine, lenalidomide, gemcitabine.
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 50
    }
  ],
  "type": "lab_value"
}

Notes

Single trigger covers both moderate (30-50) and severe (<30) — engine consumers should branch on the actual finding value to apply the correct attenuation. Per NCCN Drug Renal Dosing Tables / ASCO expert-panel 2014 (Lichtman et al.): cisplatin contraindicated CrCl <30 (substitute carboplatin Calvert AUC 4-5); HD-MTX contraindicated <50 mL/min (substitute IT MTX for CNS prophylaxis); cyclophosphamide reduce 25% at CrCl 30-50, 50% at <30; lenalidomide 10 mg (vs 25 mg) at CrCl 30-60, 15 mg q48h <30, dialysis-specific dosing. Anti-CD20 monoclonals (rituximab, obinutuzumab) and BTKi do not require renal adjustment. Multiple myeloma RF-MM-RENAL-DYSFUNCTION already exists for myeloma-specific cast-nephropathy logic.

Used By

Algorithms

ALGO-CERVICAL-LOCALLY-ADVANCED-1L - ALGO-CERVICAL-LOCALLY-ADVANCED-1L
ALGO-HGBL-DH-2L - ALGO-HGBL-DH-2L
ALGO-NK-T-NASAL-1L - ALGO-NK-T-NASAL-1L
ALGO-PCNSL-2L - ALGO-PCNSL-2L
ALGO-PMBCL-2L - ALGO-PMBCL-2L
ALGO-PTCL-2L - ALGO-PTCL-2L