Evaluation of Modification of Diet in Renal Disease study and Cockcroft-Gault equations for sitagliptin dosing

McFarland, M. Shawn; Markley, Brandon; Zhang, Ping; Hudson, Joanna Q.

doi:10.5301/jn.5000026

Cited by 9 publications

(6 citation statements)

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“…According to McFarland et al 2011, the greatest discrepancy between CG and BSA modified MDRD for the drug dosing recommendation was observed in individuals over 75 years of age. This difference may be because, the latter study used BSA modified MDRD [ 35 ]. Another study has also shown that discrepancies between CG and MDRD derived drug dosing regimens have been observed in elderly patients [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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

2017

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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.

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Section: Discussionmentioning

confidence: 99%

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

2017

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“…More appropriate new formulae have been recently proposed by nephrologists, although they are not used yet in clinical practice by diabetologists 21 . However, the coexistence of two formulae, such as Cockroft-Gault and MDRD, may lead to some discrepancies in dosing adjustment as recently illustrated with the use of sitagliptin in clinical practice 22 .…”

Section: Assessment Of Kidney Function and Stratification Of Ckd In Dmentioning

confidence: 99%

Pharmacokinetic considerations for the treatment of diabetes in patients with chronic kidney disease

Scheen¹

2013

Expert Opinion on Drug Metabolism & Toxicology

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SUMMARYIntroduction : People with chronic kidney disease (CKD) of stages 3-5 (creatinine clearance < 60 ml/min) represent 25-30% of patients with type 2 diabetes (T2DM), but the problem is underrecognized or neglected in clinical practice. However, most oral antidiabetic agents have limitations in case of renal impairment, either because they require a dose adjustment or because they are contraindicated for safety reasons. Expert Opinion : Because of potential important PK interferences and for safety reasons, the pharmacological management of T2DM should be adjusted according to kidney function. In general, the daily dose should be reduced according to glomerular filtration rate (GFR) or even the drug is contraindicated in presence of more severe CKD. This is the case for metformin (risk of lactic acidosis) and for many sulfonylureas (risk of hypoglycemia). At present, however, the exact GFR cutoff for metformin use is controversial. New antidiabetic agents are better tolerated in case of CKD, although clinical experience remains quite limited for most of them. The dose of DPP-4 inhibitors should be reduced (except for linaglitpin) whereas both the efficacy and safety of SGLT2 inhibitors are questionable in presence of CKD.

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“…Not surprisingly, however, in everyday life, sitagliptin has been shown to be frequently administered at inappropriate doses in patients with CKD [104]. Furthermore, the coexistence of two formulae to estimate renal function-the Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD) formula-may lead to some discrepancies in dosing adjustment as recently illustrated with the use of sitagliptin in clinical practice [105]. In contrast, because of its predominantly hepatobiliary excretion, linagliptin does not require any dose adjustment in the case of CKD and can be safely used in patients with various degrees of CKD (Tables 3, 4) [78,79].…”

Section: Discussionmentioning

confidence: 97%

Pharmacokinetics and Clinical Use of Incretin-Based Therapies in Patients with Chronic Kidney Disease and Type 2 Diabetes

Scheen

2014

Clin Pharmacokinet

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The prevalence of chronic kidney disease (CKD) of stages 3-5 (glomerular filtration rate [GFR] <60 mL/min) is about 25-30 % in patients with type 2 diabetes mellitus (T2DM). While most oral antidiabetic agents have limitations in patients with CKD, incretin-based therapies are increasingly used for the management of T2DM. This review analyses (1) the influence of CKD on the pharmacokinetics of dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists; and (2) the efficacy/safety profile of these agents in clinical practice when prescribed in patients with both T2DM and CKD. Most DPP-4 inhibitors (sitagliptin, vildagliptin, saxagliptin, alogliptin) are predominantly excreted by the kidneys. Thereby, pharmacokinetic studies showed that total exposure to the drug is increased in proportion to the decline of GFR, leading to recommendations for appropriate dose reductions according to the severity of CKD. In these conditions, clinical studies reported a good efficacy and safety profile in patients with CKD. In contrast, linagliptin is eliminated by a predominantly hepatobiliary route. As a pharmacokinetic study showed only minimal influence of decreased GFR on total exposure, no dose adjustment of linagliptin is required in the case of CKD. The experience with GLP-1 receptor agonists in patients with CKD is more limited. Exenatide is eliminated by renal mechanisms and should not be given in patients with severe CKD. Liraglutide is not eliminated by the kidney, but it should be used with caution because of the limited experience in patients with CKD. Only limited pharmacokinetic data are also available for lixisenatide, exenatide long-acting release (LAR) and other once-weekly GLP-1 receptor agonists in current development. Several case reports of acute renal failure have been described with GLP-1 receptor agonists, probably triggered by dehydration resulting from gastrointestinal adverse events. However, increasing GLP-1 may also exert favourable renal effects that could contribute to reducing the risk of diabetic nephropathy. In conclusion, the already large reassuring experience with DPP-4 inhibitors in patients with CKD offers new opportunities to the clinician, whereas more caution is required with GLP-1 receptor agonists because of the limited experience in this population.

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Evaluation of Modification of Diet in Renal Disease study and Cockcroft-Gault equations for sitagliptin dosing

Cited by 9 publications

References 0 publications

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

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

Pharmacokinetic considerations for the treatment of diabetes in patients with chronic kidney disease

Pharmacokinetics and Clinical Use of Incretin-Based Therapies in Patients with Chronic Kidney Disease and Type 2 Diabetes

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