Comparison of bedside estimates of renal function and measured glomerular filtration rate (GFR) in 510 adult oncology patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19512-19512
Author(s):  
M. J. Dooley ◽  
S. G. Poole ◽  
D. Rischin
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Clinical Utility ◽  
Chronic Renal Disease ◽  
Oncology Patients ◽  
Drug Dosing ◽  
Mdrd Equation ◽  
The Mean ◽  
And Gender ◽  
Measured Gfr

19512 Background: Various bedside formulae have been used in practice to estimate renal function to predict drug dosing. Recently the ‘4-variable Modification of Diet in Renal Disease’ (4-v MDRD) equation1 was derived in patients with chronic renal disease and has been advocated for application in oncology. The aim of this study was to compare measured GFR with estimates from formula based equations in adult oncology patients. Methods: GFR was determined using technetium-99m diethyl triamine penta-acetic acid (Tc99mDTPA) clearance, serum creatinine (Jaffe method) was measured and renal function estimates calculated using 4-v MDRD, Cockcroft and Gault (CGF), Wright, Martin, and Jelliffe (JF) formulae. Accuracy, bias (mean % error (MPE)) and precision were assessed for varying levels of GFR, body mass index (BMI), age and gender. Results: In 510 adult oncology patients (323 male, 187 female, mean age 63years, range 17–87years) GFR was determined using Tc99mDTPA clearance (mean 84mL/min, range 16–205mL/min). The mean (range) calculated GFR was 72mL/min/1.73m2(9–162mL/min/1.73m2), 71ml/min (11–267mL/min), 78mL/min (12- 195mL/min), 81mL/min (12–279mL/min), 64mL/min/1.73m2 (10–165mL/min/1.73m2) for 4-v MDRD, CGF, Wright, Martin, and JF formula respectively. Bias, precision and accuracy (%within 30% and 50% of true GFR) of estimates are shown in the table . The Wright and Martin formulae had greater bias relating to degree of renal function and gender respectively. The 4-v MDRD equation provided a less biased estimate compared to the CGF across all levels of renal function and BMI. Conclusions: When compared to measured GFR, the 4-v MDRD equation provides a less biased estimate compared to the other formulae evaluated across a range of variables including degree of renal function and BMI. The limitations of all the bedside estimates must be understood to allow appropriate clinical utility. 1. Levey AS, et al. Ann Intern Med 2006; 145: 247–254. [Table: see text] No significant financial relationships to disclose.

Calculating carboplatin doses using the 4-variable modification of diet in renal disease (4-v MDRD) estimate of glomerular filtration rate (GFR) in the Calvert formula

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2521-2521 ◽  
Author(s):  
S. G. Poole ◽  
M. J. Dooley ◽  
D. Rischin
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Area Under The Curve ◽  
Oncology Patients ◽  
Calvert Formula ◽  
Mdrd Equation ◽  
Gault Formula ◽  
The Mean ◽  
Carboplatin Dose ◽  
Measured Gfr

2521 Background: The dose of carboplatin is usually calculated using the Calvert formula, with various bedside estimates utilized rather than directly measured GFR. The 4-v MDRD equation (Levey AS, et al. Ann Intern Med 2006; 145: 247–254) is now advocated as the routine method of estimating renal function from serum creatinine in all patients. Adoption in clinical practice is occurring despite lack of validation in oncology patients. The aim of this study was to compare carboplatin doses derived from the Calvert formula using measured GFR and the estimates of the 4-v MDRD equation and other established estimates. Methods: GFR was determined using technetium-99m diethyl triamine penta-acetic acid (Tc99mDTPA) clearance. Serum creatinine (Jaffe method) was measured and GFR estimates calculated using 4-v MDRD, Cockcroft and Gault formula (CGF), Wright, Martin, and Jelliffe (JF) formulae. Carboplatin doses were calculated using the Calvert formula, targeting an area under the curve of 7mg.ml- 1.min-1. Results: GFR was measured in 510 adult oncology patients (323 male, 187 female, mean age 63 years, range 17–87 years, mean GFR 84 mL/min, range 16–205 mL/min). The mean (range) carboplatin dose was 765 mg (287–1,610 mg), 681 mg (237–1,306 mg), 674 mg (249–2,044 mg), 721 mg (261–1,536mg), 741 mg (261–2,128mg), 620 mg (244- 1,329 mg) for measured GFR, 4-v MDRD, CGF, Wright, Martin, and JF formulas respectively. The accuracy (% within 20% of ‘true’ dose) was 58%, 63%, 73%, 72% and 49% for 4-v MDRD, CGF, Wright, Martin, and JF formulas respectively. Carboplatin doses derived using the 4-v MDRD estimate of GFR become increasingly less accurate with increasing GFR (see table ). All other formulas performed similarly. Conclusions: The 4-v MDRD equation resulted in an imprecise estimation of carboplatin doses with the degree of variability dependant on the level of renal function. [Table: see text] No significant financial relationships to disclose.

Chronic renal disease in pregnancy: obstetric outcomes and effect of pregnancy on renal function

2011 ◽  
Vol 96 (Supplement 1) ◽  
pp. Fa102-Fa102
Author(s):  
T. J. Bonnett ◽  
A. Khalid ◽  
D. Throssell ◽  
T. Farrell ◽  
R. P. Jokhi
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Obstetric Outcomes ◽  
In Pregnancy

Effect of 1,25-(OH)2D3 on jejunal absorption of magnesium in patients with chronic renal disease

1980 ◽  
Vol 238 (4) ◽  
pp. G349-G352 ◽  
Author(s):  
A. C. Schmulen ◽  
M. Lerman ◽  
C. Y. Pak ◽  
J. Zerwekh ◽  
S. Morawski ◽  
...  
Keyword(s):  
Vitamin D ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Normal Subjects ◽  
Mean Value ◽  
Normal Serum ◽  
Perfusion Technique ◽  
Dihydroxyvitamin D3 ◽  
Jejunal Absorption ◽  
The Mean

These studies were performed to see if jejunal malabsorption of magnesium in patients with chronic renal disease was influenced by therapy with 1 alpha, 25-dihydroxyvitamin D3 [1,25-(OH)2D3; 2 microgram/day by mouth for 7 days]. This treatment restored normal serum concentrations of the vitamin D metabolite from 0.9 +/- 0.2 to 4.2 +/- 0.6 ng/dl. Jejunal absorption of magnesium, measured by a triple-lumen constant-perfusion technique, was enhanced in each of the seven patients by this therapy. The mean value rose from 0.04 +/- 0.02 to 0.13 +/- 0.02 mmol . 30 cm-1 . h-1. This last value is similar to the magnesium absorption rate in untreated normal subjects. These results demonstrate that magnesium absorption in the human jejunum is dependent on vitamin D, and they show that 1 alpha,25-dihydroxyvitamin D3 therapy in patients with chronic renal failure is associated with an enhanced jejunal absorption of magnesium.

The Use of Frusemide and Propranolol in the Treatment of the Hypertension of Chronic Renal Disease

1974 ◽  
Vol 19 (1_suppl) ◽  
pp. 25-32 ◽  
Author(s):  
R. Wilkinson ◽  
Mary Pickering ◽  
Valerie Robson ◽  
R. W. Elliott ◽  
D. N. S. Kerr
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Disease ◽  
Serum Creatinine ◽  
Marked Reduction ◽  
Chronic Renal Disease ◽  
Plasma Renin ◽  
Sodium Retention ◽  
Exchangeable Sodium ◽  
Standing Blood Pressure

Nine patients with renal disease, hypertension and impairment of renal function of varying degree have been studied before and during treatment with frusemide. In three patients observations were repeated following the addition of propranolol. In most cases frusemide resulted in a reduction of both lying and standing blood pressure but for the group the fall was not significant (P>0.05). In all patients a reduction in exchangeable sodium was achieved and the fall was significant for the group (P<0.05); this was accompanied by a significant increase in serum creatinine (P < 0.05). Plasma renin activity was increased in all patients during treatment with frusemide and the change for the group was significant (P<0.05). The addition of propranolol resulted in a marked reduction in renin in the three patients treated but in two blood pressure actually rose; in these two sodium retention had occurred following the introduction of propranolol.

scholarly journals Estimating Glomerular Filtration Rate in Black South Africans by Use of the Modification of Diet in Renal Disease and Cockcroft-Gault Equations

2008 ◽  
Vol 54 (7) ◽  
pp. 1197-1202 ◽  
Author(s):  
Hendrick E van Deventer ◽  
Jaya A George ◽  
Janice E Paiker ◽  
Piet J Becker ◽  
Ivor J Katz
Keyword(s):  
Glomerular Filtration Rate ◽  
African Americans ◽  
Renal Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Gfr ◽  
South Africans ◽  
Mdrd Equation ◽  
Black South Africans ◽  
Measured Gfr

Abstract Background: The 4-variable Modification of Diet in Renal Disease (4-v MDRD) and Cockcroft-Gault (CG) equations are commonly used for estimating glomerular filtration rate (GFR); however, neither of these equations has been validated in an indigenous African population. The aim of this study was to evaluate the performance of the 4-v MDRD and CG equations for estimating GFR in black South Africans against measured GFR and to assess the appropriateness for the local population of the ethnicity factor established for African Americans in the 4-v MDRD equation. Methods: We enrolled 100 patients in the study. The plasma clearance of chromium-51–EDTA (51Cr-EDTA) was used to measure GFR, and serum creatinine was measured using an isotope dilution mass spectrometry (IDMS) traceable assay. We estimated GFR using both the reexpressed 4-v MDRD and CG equations and compared it to measured GFR using 4 modalities: correlation coefficient, weighted Deming regression analysis, percentage bias, and proportion of estimated GFR within 30% of measured GFR (P30). Results: The Spearman correlation coefficient between measured and estimated GFR for both equations was similar (4-v MDRD R2 = 0.80 and CG R2 = 0.79). Using the 4-v MDRD equation with the ethnicity factor of 1.212 as established for African Americans resulted in a median positive bias of 13.1 (95% CI 5.5 to 18.3) mL/min/1.73 m2. Without the ethnicity factor, median bias was 1.9 (95% CI −0.8 to 4.5) mL/min/1.73 m2. Conclusions: The 4-v MDRD equation, without the ethnicity factor of 1.212, can be used for estimating GFR in black South Africans.

scholarly journals Concordance Among Methods for Empiric Renal Drug Dosing: Meropenem as a Role Model for Clinical Superiority of Cockroft–Gault or Modification of Diet in Renal Disease

2018 ◽  
Vol 10 ◽  
pp. 1179559X1877776
Author(s):  
Sabaa M Al Jasmi ◽  
Amer H Khan ◽  
Loai M Saadah ◽  
Syed Azhar Syed Sulaiman ◽  
Doaa Kamal Al Khalidi
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Role Model ◽  
Simulated Data ◽  
Adverse Outcomes ◽  
Drug Dosing ◽  
Disease Epidemiology ◽  
Actual Patient ◽  
Specific Medication ◽  
Clinically Significant

Objective: The objectives of this study are, first, to measure concordance between 5 different renal function estimates (methods) in terms of recommended drug doses, and, subsequently, to establish the potential for significant clinical differences between Cockroft–Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations in dosing a specific medication, namely, meropenem. Design and setting: This study used a Monte Carlo simulation, and this is a computer–based study with no actual patient data. Patients: A total of 1200 and 8701 simulated cases to study the concordance for the 5 methods and the potential clinical significance of discordance between CG and MDRD, respectively, were chosen for the study. Methods: Simulated factors were age, sex, height, weight, serum creatinine, ethnicity, and albumin. We estimated the renal function using 5 formulas (ie, 10 combinations) including CG, MDRD, and Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI). Next, the team evaluated concordance for each combination in dosing 22 drugs. Finally, our researchers reviewed and simulated data from the literature to show how CG versus MDRD use can result in clinically significant differences for meropenem. Results: Pairwise combinations yielded statistically significant differences ( P < .0001) except for CG and MDRD ( P < .5147). In addition, the highest concordance was for MDRD and CKD–EPI. Average discordance is in the range of 25% to 30% with the lowest being between CG and albumin–based estimates. Both CG and MDRD were largely discordant which can reach up to 40% with a drug like meropenem and may be associated with significant adverse outcomes. Conclusions: Both CG and MDRD in our simulation are statistically comparable. Clinically, nonetheless, they are significantly inconsistent in terms of recommended drug dosing. We encourage practical comparisons of outcomes for individual or groups of medications (eg, meropenem and antibiotics) empirically dosed in renal patients on the basis of equations used in distinct populations.

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