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

2021 ◽  
pp. 106002802110102
Author(s):  
Janine Miller ◽  
John P. Knorr
Keyword(s):  
Filtration Rate ◽  
Drug Dosage ◽  
Drug Dose ◽  
Epidemiology Study ◽  
Black African ◽  
Drug Dosing ◽  
Disease Epidemiology ◽  
Black Patients ◽  
The Impact ◽  
Level Of Agreement

Background The appropriateness of including the race coefficient in glomerular filtration rate (GFR) equations in Black patients is debated, and the impact on drug dosing is unknown. Objective This study explored the impact of removing the race coefficient on drug dosing in Black patients in comparison to conventional methods. Methods This was a retrospective study of hospitalized patients who self-identified as Black/African American and were prescribed an antimicrobial that includes renal dosage recommendations in the product labeling. The primary end point was the discordance between drug dosing recommendations derived by body surface area deindexed GFR estimated by the CKD-EPI equation (Chronic Kidney Disease Epidemiology study) with and without race versus recommendations derived from Cockcroft-Gault (CG). Results A total of 210 Black patients were included. There was an 18% rate of discordance when GFR was estimated with the race coefficient (GFR w/Race) versus without the race coefficient (GFR w/out Race). GFR w/out Race had a higher level of agreement with dosing by creatinine clearance (CrCl; κ = 0.779) than GFR w/Race versus CrCl (κ = 0.651). GFR w/out Race had less within-patient difference than GFR w/Race in comparison to CrCl (mean difference: −6.3 vs −18.0 mL/min). Conclusions and Relevance This represents the first report to examine the removal of the race coefficient and its implication on drug dose discordance. GFR w/out Race had a higher level of agreement and less drug dose discordance than GFR w/Race, in comparison to CrCl estimates. If GFR equations are considered comparable to CrCl for the purposes of guiding drug dosing, GFR w/out Race should be considered.

Principles of Drug Therapy in Reduced Kidney Function

2019 ◽  
pp. 211-218
Author(s):  
Timothy Nguyen ◽  
Tran Tran ◽  
Thomas Dowling
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
Filtration Rate ◽  
Drug Dosage ◽  
Epidemiology Study ◽  
Disease Epidemiology ◽  
Prescribing Practice ◽  
Disease Study ◽  
Improving Patient Care ◽  
Reduced Kidney Function

The prevalence of kidney disease is high. Most drugs are excreted by the kidneys and drug dosage adjustments are likely required in renal impairment to avoid accumulation and exposure-related toxicity. Kidney disease affects physiological changes and alterations in the pharmacokinetics and the pharmacodynamics of many drugs. Glomerular filtration rate is considered the best overall index of kidney function. Kidney function can be assessed by using endogenous and exogenous markers such as serum creatinine, inulin, cystatin C, radionuclide-labeled, estimated equations for creatinine clearance such as Cockcroft-Gault, and estimated equations for GFR such as the Modification of Diet in Renal Disease study equation, and the Chronic Kidney Disease Epidemiology Collaboration Epidemiology study equation. Applying good prescribing practice is important for limiting drug toxicities and improving patient care.

Performance of the Chronic Kidney Disease-Epidemiology Study Equations for Estimating Glomerular Filtration Rate Before and After Nephrectomy

2010 ◽  
Vol 183 (3) ◽  
pp. 896-902 ◽  
Author(s):  
Brian R. Lane ◽  
Sevag Demirjian ◽  
Christopher J. Weight ◽  
Benjamin T. Larson ◽  
Emilio D. Poggio ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Epidemiology Study ◽  
Disease Epidemiology ◽  
Before And After

EXPRESS: Drug dosing using estimated Glomerular Filtration Rate: Misclassification due to metamizole interference in a creatinine assay

2021 ◽  
pp. 000456322110200
Author(s):  
Luana Bojko ◽  
Gustavo de Paula Ripka ◽  
Laura Mattana Dionísio ◽  
Celso Luiz Borges ◽  
Danielle Cristyane Kalva Borato ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Drug Dosing ◽  
Significant Difference ◽  
The Impact ◽  
Creatinine Measurement

The estimated glomerular filtration rate is a rather important measurement for patients under intensive care, since they often receive several drugs, and impaired renal function may result in misleading dosing. The estimated glomerular filtration is derived from mathematical models using serum creatinine, a measurement that suffers interference of some drugs, such as metamizole. The study intented to evaluate the impact on patient stratification for dose adjustment of two antimicrobials (meropenem and vancomycin) caused by metamizole interference in creatinine measurement by dry chemistry. A cross-sectional study was conducted with a group of 108 hospitalized patients under metamizole prescriptions at fixed intervals. Serum creatinine levels were determined by enzymatic dry chemistry and Jaffé assays and the estimated glomerular filtration rate was calculated through the CKD-EPI equation. Patients were stratified in groups according to their estimated glomerular filtration rate for drug dosing of vancomycin and meropenem. As expected, creatinine values were significantly lower in measurements performed by the dry chemistry method in comparison to Jaffé assay (p<0.0001) when patients are under metamizole treatment. A significant bias (-40.3%) was observed between those two methods, leading to a significant difference (p<0.0001) in patient classification according to renal function using the CKD-EPI equation for dosing adjustment. Thus, during the validity of metamizole treatment, the stratification for drug dosing by the estimated glomerular filtration rate is not reliable if the creatinine measurement is done through dry chemistry. Clinical and laboratory staff must be aware of these limitations and cooperate to optimize pharmacotherapy.

scholarly journals Clinical Implications of the New Equation to Estimate Glomerular Filtration Rate

Nephron ◽  
2021 ◽  
pp. 1-5
Author(s):  
Davide Giavarina ◽  
Faeq Husain-Syed ◽  
Claudio Ronco
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Significant Proportion ◽  
Disease Epidemiology ◽  
Estimation Equations ◽  
Estimate Glomerular Filtration Rate ◽  
Gfr Estimation ◽  
New Equation ◽  
The Impact

Recently, a new full-age spectrum equation was proposed by the European Kidney Function Consortium (EKFC) to overcome the difficulty of using multiple glomerular filtration rate (GFR) estimation equations and problems of implausible changes in GFR during the transition from adolescence to adulthood and address GFR overestimation in young adults and in the older adults. To verify the impact on patient classifications, we applied the new equation to data of 38,188 adult patients, comparing GFR estimation using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and EKFC equations. As expected, our data indicate that a significant proportion of patients will be reclassified downward by the EKFC compared to the CKD-EPI equation with a particular reference between CKD stages 1–2 and 2–3 and age categories of 18–30 and ≥61 years, respectively. Clinicians should be aware that any replacement for the EKFC equation will entail a period of different results in estimated GFR during the transition from the previous to the new equation.

Comparing glomerular filtration rate equations and the impact of different creatinine assays on the assessment of renal function in cancer patients

2019 ◽  
Vol 56 (2) ◽  
pp. 266-274 ◽  
Author(s):  
Ashley E Garner ◽  
Mark C Barnfield ◽  
Michael L Waller ◽  
Geoff D Hall ◽  
Mike P Bosomworth
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cancer Patients ◽  
Filtration Rate ◽  
Rate Equations ◽  
Disease Epidemiology ◽  
Estimate Glomerular Filtration Rate ◽  
The Impact ◽  
Better Than

Background Equations to estimate glomerular filtration rate based on serum creatinine are commonly used in cancer patients to assess renal function. However, there is uncertainty regarding which equation is most appropriate for this population and the impact of different creatinine assays. Methods Measured isotopic glomerular filtration rate results from 120 oncology patients were used to evaluate and compare all four versions of the Wright equation, Cockcroft and Gault, Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration and the Janowitz and Williams formula; using eight different creatinine assays (five Jaffe, three enzymatic). Results The enzymatic version of the Wright equation without creatine kinase performed better than the other versions for all eight creatinine assays. However, MDRD and Janowitz and Williams gave the best overall performance in this patient population. Performance was highly dependent on the creatinine assay used, for example, the percentage of results within 30% of the isotopic glomerular filtration rate (P30) ranged from 90.8% to 60.8% for MDRD. Conclusion The performance of any equation to estimate glomerular filtration rate is highly dependent on the creatinine assay used. Oncology units should assess the performance of glomerular filtration rate equations using their laboratory creatinine assay to determine whether they can be used safely and effectively in cancer patients.

scholarly journals Accuracy of freely available online GFR calculators using the CKD-EPI equation

2020 ◽  
Vol 76 (10) ◽  
pp. 1465-1470
Author(s):  
Sarah Seiberth ◽  
Theresa Terstegen ◽  
Dorothea Strobach ◽  
David Czock
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dose Adjustment ◽  
Filtration Rate ◽  
Clinical Decision Making ◽  
Estimated Glomerular Filtration Rate ◽  
Clinical Decision ◽  
Drug Dose ◽  
Disease Epidemiology ◽  
Drug Dose Adjustment

Abstract Purpose Estimated glomerular filtration rate (eGFR) as calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is used for detection of chronic kidney disease and drug dose adjustment. The purpose of the present study was to investigate the accuracy of freely available eGFR online calculators. Methods All identified CKD-EPI online calculators were run with five reference cases differing in age, sex, serum creatinine, and ethnicity. Conversion from eGFRindexed (unit ml/min per 1.73 m2) to eGFRnon-indexed (unit ml/min) and creatinine unit from milligramme/decilitre to micromole/litre was checked, if available. Results Only 36 of 47 calculators (76.6%) produced accurate eGFR results for all reference cases. Eight of 47 (17.0%) calculators were considered as faulty because of errors relating to ethnicity (4 calculators), to conversion of the eGFR unit (2 calculators), to erroneous eGFR values without obvious explanation (2 calculators), to conversion of the creatinine unit (1 calculator), and to an error in the eGFR unit displayed (1 calculator). Overall, 28 errors were found (range 59 to 147% of the correct eGFR value), the majority concerning calculation of eGFRindexed and the conversion to eGFRnon-indexed. Only 7 of 47 (14.9%) calculators offered conversion of the eGFR unit. Conclusions Erroneous calculations that might lead to inappropriate clinical decision-making were found in 8 of 47 calculators. Thus, online calculators should be evaluated more thoroughly after implementation. Conversion of eGFR units that might be needed for drug dose adjustments should be implemented more often.

scholarly journals The Glomerular Filtration Rate Estimators in the Pharmacokinetic Modelling in Acute Kidney Injury: An Observational Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 158
Author(s):  
Silvijus Abramavicius ◽  
Vaidotas Galaune ◽  
Agile Tunaityte ◽  
Astra Vitkauskiene ◽  
Gintautas Gumbrevicius ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Drug Development ◽  
Glomerular Filtration ◽  
Renal Clearance ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Drug Dose ◽  
Population Pharmacokinetic ◽  
Drug Dosing

The glomerular filtration rate (GFR), according to which the drug dose for patients with chronic kidney disease (CKD) is adjusted, is computed with estimators (eGFR) that are developed specifically for CKD. These particular types of estimators are also used in population pharmacokinetic (pop PK) modelling in drug development. Similar approaches without scientific validation have been proposed for patients with acute kidney injury (AKI), yet it is uncertain which specific eGFR should be used for drug dosing or in pop PK models in patients with AKI. In our study, we included 34 patients with AKI and vancomycin (VCM) treatment, and we built both individual PK and pop PK (non-linear mixed-effects, one-compartment) models to see which eGFR estimator is the best covariate. In these models different eGFRs (Cockcroft-Gault, MDRD, CKD-EPI 2009, Jelliffe and Jelliffe, Chen et al., and Yashiro et al. 2013) were used. We included six additional patients to validate the final pop PK model. All eGFRs underrate the true renal clearance in the AKI, so we created pop PK models for VCM dosing in AKI with all eGFRs, to discover that the most accurate model was the one with the Cockcroft-Gault estimator. Since the eGFRs underestimate the true renal clearance in AKI, they are inaccurate for clinical drug dosing decisions, with the exception of the Cockcroft-Gault one, which is appropriate for the pop PK models intended for drug development purposes in AKI.

Sign in / Sign up

Export Citation Format

Share Document