Use of estimated glomerular filtration rate for drug dosing in the chronic kidney disease patient

Hudson, Joanna Q.; Nyman, Heather

doi:10.1097/mnh.0b013e328348c11f

Cited by 34 publications

(26 citation statements)

References 34 publications

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“…In spite of the limitations, estimation of GFR is an essential clinical assessment parameter to monitor patients with kidney disease including RTRs. 24 Repeat measurement of CrCl and its relationship to e-GFR in RTRs including racial subpopulations has not been reported. These data provide an assessment of CrCl-12 h and e-GFR in closely monitored clinically stable African American and Caucasian RTRs.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 12-Hour Creatinine Clearance and Estimated Glomerular Filtration Rate in Renal Transplant Recipients

et al. 2013

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Glomerular filtration rate (GFR) is an essential clinical assessment of renal function post-renal transplantation. Creatinine clearance (CrCl) measured over 12 h and estimated GFR (e-GFR) (calculated by the Modification of Diet in Renal Disease equation) were compared in 28 stable renal transplant recipients (RTRs). This single center study included 14 African American (AA) and 14 Caucasian (CC) recipients. The 12-h creatinine clearance (CrCl-12 h) was determined by monitored urine collection and by e-GFR on two occasions (two phases) separated by at least 2 weeks. Statistics included mixed model analysis of CrCl-12 h and e-GFR relative to race, phase, and difference between parameters. In the first phase, the e-GFR was higher in AA males (58.4 AE 14.8 mL/min) than the CC males (46.2 AE 10.2 mL/min) ( p ¼ 0.032), whereas the CrCl-12 h of AA males (70.8 AE 8.7 mL/min) and CC males (63.3 AE 21.7 mL/min) was not different ( p ¼ 0.740). During the second phase, the e-GFR in AA and CC RTRs was 55.4 AE 10.1 mL/min and 47.6 AE 10.7 mL/min ( p ¼ 0.117), respectively, whereas CrCl-12 h in AAs was 64.71 AE 17.9 mL/min and in CCs was 62.0 AE 14.9 mL/min ( p ¼ 1.000). The CrCl-12 h was higher than the e-GFR ( p < 0.001) irrespective of race or phase. CrCl-12 h was not different on both occasions ( p ¼ 0.289) in all the patients. CrCl-12 h was consistently greater than e-GFR. The difference between these e-GFR estimates may have an importance in the care of RTRs.

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Section: Discussionmentioning

confidence: 99%

Comparison of 12-Hour Creatinine Clearance and Estimated Glomerular Filtration Rate in Renal Transplant Recipients

et al. 2013

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“…Precise knowledge of GFR might be of value in patients, such as mine, who may have symptoms suggestive of uremia given that symptoms of uremia can be subtle and are nonspecific, medication dosing (or avoidance) (57)(58)(59), use of contrast media, assessing individuals considering living kidney donation (60)(61)(62) or who are transplant recipients (63), and planning timing of dialysis access or the start of dialysis and transplantation. Knowing the measured GFR might be important also when trying to assess kidney function in patients who are elderly (64), are morbidly obese, have significant nonrenal acute or chronic illness, have reduced muscle mass, have liver disease, have malnutrition, or had an amputation.…”

Section: Discussionmentioning

confidence: 99%

“…There also seems to be substantial drug-dosing discordance in older individuals comparing MDRD and CKD-EPI equations (76). It is not clear which formula is superior in terms of maximizing drug efficacy and minimizing drug toxicity (58,75).…”

Section: Answermentioning

confidence: 99%

Clinical Decision Making in a Patient with Stage 5 CKD—Is eGFR Good Enough?

Berns

2015

Clinical Journal of the American Society of Nephrology

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The development and widespread use of serum creatinine concentration-based prediction equations to calculate eGFR have been major advances for detection of patients with CKD and the epidemiologic study of CKD and its outcomes. However, these equations as well as those that also incorporate serum cystatin C concentration provide GFR estimates that, although reasonably precise on average, can differ markedly and in clinically important ways from actual GFR. Thus, it is important that clinicians who use these equations for clinical decisionmaking be familiar with their strengths and weaknesses and have an appreciation of their potential for error. More precise knowledge of actual GFR is important in certain clinical circumstances, including, as presented in this Attending Rounds, patients with stage 5 CKD, in whom decisions regarding dialysis initiation are necessary. Nephrologists should have the ability to accurately determine GFR when needed if clinical circumstances suggest inaccuracy of the calculated eGFR reported by the clinical laboratory.

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“…For example, drug administration, including antibiotics and other therapeutic treatments, often require dose adjustments according to patients' estimated renal function. 14,15 In the hospital setting, serum creatinine is an important and convenient laboratory marker that can help to identify patients suffering from acute or chronic renal disease. However, measurement of serum creatinine alone is not the most accurate way of evaluating a patient's true renal function, because numerous factors influence the baseline level of serum creatinine production, including age, sex, dietary intake, and muscle mass.…”

Section: Assessment Of Kidney Function In the Hospital Settingmentioning

confidence: 99%

Evaluation of Acute Kidney Injury in the Hospital Setting

Eftekhari

2014

Primary Care: Clinics in Office Practice

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Use of estimated glomerular filtration rate for drug dosing in the chronic kidney disease patient

Abstract: The Cockcroft-Gault, MDRD, and CKD-EPI equations provide reasonable estimates of kidney function; however, clinicians must understand the limitations when using these estimates for drug regimen design.

Cited by 34 publications

References 34 publications

Comparison of 12-Hour Creatinine Clearance and Estimated Glomerular Filtration Rate in Renal Transplant Recipients

Comparison of 12-Hour Creatinine Clearance and Estimated Glomerular Filtration Rate in Renal Transplant Recipients

Clinical Decision Making in a Patient with Stage 5 CKD—Is eGFR Good Enough?

Evaluation of Acute Kidney Injury in the Hospital Setting

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