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[Purpose] This study aims to determine the effects of unidentified renal insufficiency (URI) on the safety and efficacy of chemotherapy for metastatic colorectal cancer (mCRC) patients.[Methods] Medical records of mCRC patients with normal serum creatinine and who were treated with XELOX as the first-line therapy were retrospectively reviewed.Creatinine clearance (CrCL) was estimated using the Cockcroft-Gault formula.URI characterized by a CrCL of less than 60 ml/min.Logistic regression was used to assess the effects of URI on toxicities and response rates.Kaplan-Meier curve was used to evaluate the effect of URI on survival.[Results] A total of 143 patients were enrolled,of whom 34.9% had URI.Compared with the control group,the URI group had longer toxicity durations and developed significantly more grade 1 to 2 toxicities after adjusting for age,gender,and body mass index.The toxicities include myelosuppression (76.0% vs.60.5%,OR=1.86,95%CI=0.39~6.53,P<0.001),diarrhea (34.0% vs.29.0%,OR=3.76,95% CI=0.95~11.53,P< 0.001) ,stomatitis(10.0% vs.6.45%, OR=2.81,95% CI=1.10~4.28, P<0.001), and hand-foot syndrome (18.0% vs.6.45%,OR=2.56,95% CI=0.86~5.41, P=0.006).The response rate and time to progression were significantly lower in the URI group than that in the control group (4.5 months vs.5.5 months,Log-rank 7.259, P=0.007),whereas the overall survival rates of the two groups were similar.[Conclusions] URI can increase the toxicity and decrease the survival of XELOX-treated mCRC patients.Renal function screening via CrCL estimation is required for all mCRC patients before initial chemotherapy.