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. 2022 May;88(5):2118-2127.
doi: 10.1111/bcp.15132. Epub 2021 Dec 3.

Performance of creatinine-based equations to estimate glomerular filtration rate with a methodology adapted to the context of drug dosage adjustment

Pierre Delanaye  1   2 , Jonas Björk  3   4 , Marie Courbebaisse  5 , Lionel Couzi  6 , Natalie Ebert  7 , Björn O Eriksen  8 , R Neil Dalton  9 , Laurence Dubourg  10 , Francois Gaillard  11 , Cyril Garrouste  12 , Anders Grubb  13 , Lola Jacquemont  14 , Magnus Hansson  15 , Nassim Kamar  16 , Edmund J Lamb  17 , Christophe Legendre  18 , Karin Littmann  19 , Christophe Mariat  20 , Toralf Melsom  8 , Lionel Rostaing  21 , Andrew D Rule  22 , Elke Schaeffner  7 , Per-Ola Sundin  23 , Ulla B Berg  24 , Kajsa Åsling-Monemi  24 , Luciano Selistre  25 , Anna Åkesson  3   4 , Anders Larsson  26 , Arend Bökenkamp  27 , Hans Pottel  28 , Ulf Nyman  29
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Free article

Performance of creatinine-based equations to estimate glomerular filtration rate with a methodology adapted to the context of drug dosage adjustment

Pierre Delanaye et al. Br J Clin Pharmacol. 2022 May.
Free article

Abstract

Aim: The Cockcroft-Gault (CG) creatinine-based equation is still used to estimate glomerular filtration rate (eGFR) for drug dosage adjustment. Incorrect eGFR may lead to hazardous over- or underdosing.

Methods: In a cross-sectional analysis, CG was validated against measured GFR (mGFR) in 14 804 participants and compared with the Modification-of-Diet-in-Renal-Diseases (MDRD), Chronic-Kidney-Disease-Epidemiology (CKD-EPI), Lund-Malmö-Revised (LMR) and European-Kidney-Function-Consortium (EKFC) equations. Validation focused on bias, imprecision and accuracy (percentage of estimates within ±30% of mGFR, P30), overall and stratified for mGFR, age and body mass index at mGFR <60 mL/min, as well as classification in mGFR stages.

Results: The CG equation performed worse than the other equations, overall and in mGFR, age and BMI subgroups in terms of bias (systematic overestimation), imprecision and accuracy except for patients ≥65 years where bias and P30 were similar to MDRD and CKD-EPI, but worse than LMR and EKFC. In subjects with mGFR <60 mL/min and at BMI 18.5-25 kg/m2 , all equations performed similarly, and for BMI < 18.5 kg/m2 CG and LMR had the best results though all equations had poor P30-accuracy. At BMI ≥ 25 kg/m2 the bias of the CG increased with increasing BMI (+17.2 mL/min at BMI ≥ 40 kg/m2 ). The four more recent equations also classified mGFR stages better than CG.

Conclusions: The CG equation showed poor ability to estimate GFR overall and in analyses stratified for mGFR, age and BMI. CG was inferior to correctly classify the patients in the mGFR staging compared to more recent creatinine-based equations.

Keywords: chronic kidney disease; drug adjustment; glomerular filtration rate.

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References

REFERENCES

    1. Pottel H, Björk J, Courbebaisse M, et al. Development and validation of a modified full age spectrum creatinine-based equation to estimate glomerular filtration rate. A cross-sectional analysis of pooled data. Ann Intern Med. 2021;174(2):183-191.
    1. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-612.
    1. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
    1. Verbeeck RK, Musuamba FT. Pharmacokinetics and dosage adjustment in patients with renal dysfunction. Eur J Clin Pharmacol. 2009;65(8):757-773.
    1. Dreisbach AW, Flessner MF. Drug metabolism and chronic kidney disease. In: Kimmel PL, Rosenberg MK, eds. Chronic Renal Disease. Vol First Edit. Elsevier; 2014:674-681.

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