Evaluation of methods to estimate glomerular filtration rate versus actual drug clearance in patients with chronic spinal cord injury

Lee, J P; Dang, Alexander

doi:10.1038/sc.2011.82

Cited by 14 publications

(25 citation statements)

References 17 publications

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“…Elderly patients or those with paralysis and amputations have lower S cr secondary to reduced muscle mass . This has led some clinicians to advocate for rounding S cr values to 0.8 or 1.0 for patients with S cr values below 0.8, although this remains controversial .…”

Section: Discussionmentioning

confidence: 99%

National assessment of renal estimation for drug dosing among pharmacists

McConachie

Hanni

Raub

et al. 2018

J Am Coll Clin Pharm

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Introduction Creatinine‐based equations used to estimate renal function are inaccurate in certain clinical contexts; however, there are limited resources to guide pharmacists in these situations. Objectives To assess current renal function estimation and subsequent drug dosing practices among American College of Clinical Pharmacy (ACCP) members via an electronic survey. Methods A 21‐item survey was emailed to the listservs of four ACCP Practice‐Research Networks: Adult Medicine, Nephrology, Critical Care, and Infectious Diseases. The survey included pharmacist demographics, practice site information, and case‐based clinical application scenarios requiring the respondent to choose a renal function estimate for overweight, underweight, and elderly patients (≥65 years). Four patient cases captured respondents' enoxaparin dosing decisions in patients with an estimated creatinine clearance of around 30 mL/min. Estimates of renal function were provided based on Cockcroft‐Gault (C‐G), Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology equations. Results There were 299 survey responses. The majority of respondents were pharmacists (98%) who practiced in the hospital setting (96%) as clinical specialists (69%). The C‐G equation was chosen to estimate renal function most commonly (85%). Total and adjusted body weights were used in C‐G estimates most commonly in patients who were underweight (80%) and overweight (75%), respectively. Given an elderly patient with low serum creatinine (Scr), 34% of respondents used actual Scr, 30% rounded Scr to 0.8, and 29% rounded Scr to 1.0 for use in C‐G. Enoxaparin renal dose adjustment differed based on clinical indication. Respondents chose more frequent (every 12 hour) dosing in patients with pulmonary embolism vs atrial fibrillation. Of the 79% of respondents whose practice site utilizes pharmacist‐driven renal dose adjustment policies, 94% indicated they deviated from the policy. Conclusion Large variation exists among clinical pharmacists in the application of renal function estimating equations which may impact dosing strategies and patient care.

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Section: Discussionmentioning

confidence: 99%

National assessment of renal estimation for drug dosing among pharmacists

McConachie

Hanni

Raub

et al. 2018

J Am Coll Clin Pharm

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“…In 2011, Lee and Dang published the results of a retrospective pharmacokinetic analysis of data on 141 patients with long-term SCI/D in the Veterans Affairs (VA) hospital with the largest inpatient SCI center in the VA system. The investigators evaluated frequently employed methods to estimate GFR (CL CG , modified CG, CL 24H, MDRD, and CKD-EPI) against patientspecific drug clearance of vancomycin and AG (CL DRUG ) [16]. Table 3 shows that all methods overestimate CL DRUG (p <0.001).…”

Section: Evaluation Of Different Methods Of Estimating CL Cr or Gfr Cmentioning

confidence: 99%

“…CL 24H (mL/min) = [urine creatinine x urine volume (mL)] / [SCr x time (hours) x 60] Current literature reports that CL 24H better predicts renal function compared to CL CG and MDRD in paraplegia, however this method is not routinely utilized for drug dosing due to the impracticability of collecting multiple urine samples as well as the propensity for error from serial collections [8,16].…”

Section: -Hour Endogenous Creatinine Clearance (Cl 24h )mentioning

confidence: 99%

“…In addition to high prevalence of traditional risk factors for CKD such as advanced age, diabetes, hypertension, and cardiovascular disease, individuals with paraplegia have elevated incidence of recurrent and chronic urinary tract infections, neurogenic bladder dysfunction, and nephrolithiasis that put them at risk for developing CKD [2][3][4][5][6]. Fischer et al conducted cross-sectional analyses of data on 9333 Veterans with spinal cord injury and disorder (SCI/D) and found that the prevalence of CKD in SCI/D was approximately 35%, considerably higher based on the modified MDRD for SCI/D than 10% based on the original MDRD [15] Lee and Dang (2011) [16] Lavezo et al…”

Section: Introductionmentioning

confidence: 99%

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Estimating Renal Function in Paraplegia

Lee¹

2014

Topics in Paraplegia

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“…In 2011, Lee (one of the authors of the study described in this article) and Dang published the results of a retrospective pharmacokinetic analysis of data on 141 patients with long-term SCI (injury duration >1 year) in the Veterans Affairs (VA) hospital with the largest inpatient SCI center in the VA system [6]. The authors developed a more accurate method of estimating the glomerular filtration rate (GFR) or creatinine clearance (CL CR ) based on vancomycin clearance (CL VANCO ) in SCI patients: CL CR (ml/min) = 2.3 × CL M 0.7 , where CL M corresponds to a modified CG method with serum creatinine (SCr) rounded to 1 mg/dl for all patients with SCr <1 mg/dl while using the actual SCr for patients with SCr ≥1 mg/dl.…”

Section: Introductionmentioning

confidence: 99%

Prospective Analysis of Various Dosing Methods for Aminoglycosides and Vancomycin Therapy in Chronic Spinal Cord Injury Patients

Lee

Truong²

2015

Nephron

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Background/Aim: Several methods have been proposed for the better estimation of creatinine clearance (CL_CR) in spinal cord injury (SCI); however, there is no standard method to date. In 2011, Lee-Dang derived an equation to predict CL_CR more accurately, although it was limited by problems inherent in any retrospective study of previously collected data. Thus, a prospective investigation was conducted to evaluate the feasibility of clinical implementation and accuracy of the Lee-Dang method against 5 other methods while controlling sources of bias and confounding. Methods: A prospective investigation included 100 patients who met the inclusion criteria, given as follows: a diagnosis of SCI and administration of intravenous aminoglycosides (AG) or vancomycin with their dosing regimen determined by the Lee-Dang equation. The percentage of patients achieving therapeutic goal was determined, and the measured AG and vancomycin drug clearance (mCL_DRUG) values were compared with the results that were estimated from 6 equations. Results: The Lee-Dang equation was found to be more accurate, with a smaller magnitude of variance from mCL_DRUG and smaller residuals and bias compared with the alternatives. The Lee-Dang method resulted in >90% of patients achieving the steady state serum concentrations within the pre-defined goal for AG and vancomycin. All other predictive methods grossly overestimated CL_CR and produced markedly lower frequency (<50%) of achieving the goal for both antimicrobials (p < 0.05). Conclusion: The prospective data shows that the Lee-Dang method for predicting CL_CR is more accurate relative to the alternative methods in the study population with SCI, thus recommend using the Lee-Dang method for pharmacokinetic dosing of AG and vancomycin in SCI.

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Evaluation of methods to estimate glomerular filtration rate versus actual drug clearance in patients with chronic spinal cord injury

Cited by 14 publications

References 17 publications

National assessment of renal estimation for drug dosing among pharmacists

National assessment of renal estimation for drug dosing among pharmacists

Estimating Renal Function in Paraplegia

Prospective Analysis of Various Dosing Methods for Aminoglycosides and Vancomycin Therapy in Chronic Spinal Cord Injury Patients

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