Concordance between modification of diet in renal disease, chronic kidney disease epidemiology collaboration and Cockcroft-Gault equations in patients with chronic kidney disease at St. Paul’s hospital millennium medical college, Addis Ababa, Ethiopia

Abstract

BackgroundThe most commonly used glomerular filtration rate estimating equations for drug dosing are Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. However there is still a concern about whether to use MDRD and CKD-EPI interchangeably with CG for drug dosage adjustment.MethodsThe study was initiated to determine the concordance between MDRD, CKD-EPI and CG equations and associated factors in patients with chronic kidney disease at Saint Paul’s Hospital Millennium Medical College (SPHMMC). This was a cross sectional study which involved patient chart review and physicians self-administered questionnaire. Serum creatinine level ≥ 1.2 mg/dL was used as a cutoff point in pre-selection of patients. The correctness of the drug dose prescribed for the level of renal function were compared to the drug database (Lexi-Comp) available through Up-to-date version 21.2.ResultsAmong the total of 422 patients, 249 (59%) were males. Mean age of patients was 46.09 years. The use of MDRD equation for drug dose adjustment by physicians working in the renal clinic of SPHMMC was six out of nine physicians. The Pearson correlation coefficient between the CG with MDRD and CKD-EPI equations was r = 0.94, P < 0.001 and r = 0.95, P < 0.001, respectively. The concordance between the CG with MDRD and CKD-EPI equations for FDA assigned kidney function categories was 73.7%, Kappa = 0.644 and 74.9%, Kappa = 0.659, respectively. Concordance between the CG with MDRD and CKD-EPI equations for the drug dosing recommendation was 89.6%, kappa = 0.782 and 92%, kappa = 0.834, respectively. Age > 70 years was associated with discordance between CG and MDRD equations for drug dosing recommendation whereas serum creatinine 1.2–3.5 mg/dL, weight < 61 Kg and age > 70 years were associated with discordance between the CG with MDRD and CKD-EPI equations for FDA assigned kidney function categories. However, none of the factors associated with discordance between CG and CKD-EPI for drug dosing.ConclusionMDRD equation can be used interchangeably with CG equation for drug dosing recommended in all adult patients between the age of 18 and 70 years. CKD-EPI can be used interchangeably with CG in all adult Ethiopian patients with CKD.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0783-3) contains supplementary material, which is available to authorized users.

Impact of Removing the Race Coefficient in Renal Function Estimate Equations on Drug Dosage Recommendations

“…Recent literature has recommended CKD-EPI as the most accurate renal function estimate equation, and national recommendations suggest that GFR estimates may be used as alternatives to CrCl to assess renal function for drug dosage recommendations. 12,15 The CKD-EPI equation includes variables for SCr, age, and sex and a coefficient to adjust for Black race. However, research has emerged raising concern about a potential overestimation of GFR in Black patients when utilizing the CKD-EPI equation.…”

“…Previous studies have identified differences between renal function estimates among Black patients. 12,[16][17][18][19][20][21] Booysen et al 20 and Omuse et al 17 reported that CKD-EPI was the most accurate estimate in Black South Africans and Kenyans, respectively. However, Eastwood et al 18 determined that CKD-EPI without race was more accurate in lean Black patients in Ghana.…”

“…However, Eastwood et al 18 determined that CKD-EPI without race was more accurate in lean Black patients in Ghana. A clinical trial conducted by Dinsa et al 12 evaluated 422 patients with a baseline SCr >1.2 mg/dL in a renal clinic based in Ethiopia. Although this trial did not compare eGFR w/out Race, they found a greater than 20% drug dose discordance rate between eGFR equations and CrCl.…”

“…11 Despite this, the National Institute of Diabetes and Digestive and Kidney Diseases Laboratory Working Group recommends eGFR as an alternative to CrCl for drug dosing, and several recently approved medications include dosage recommendations based on eGFR. 12,13 The aim of this study is to investigate the impact of removing the race coefficient from the CKD-EPI equation on renal dosage adjustment recommendations in a predominantly Black patient population.…”

Effect of ciprofloxacin vs levofloxacin on QTc‐interval and dysglycemia in diabetic and non‐diabetic patients

“…Alanine transaminase (ALT), aspartate transaminase (AST), serum magnesium, blood glucose, and serum creatinine were determined by an automated analyser (Beckman Coulter AU480, Kraemer Blvd., Brea, CA 92 821 USA) 37‐39 . Creatinine clearance (CrCl) was measured by Cockcroft and Gault formula (CG) using serum creatinine values on all patients 40 …”