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Comparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function.
Am J Geriatr Pharmacother. 2008 Aug; 6(3):153-60.AJ

Abstract

BACKGROUND

The National Kidney Foundation's practice guidelines for chronic kidney disease recommend using the Modification of Diet in Renal Disease (MDRD) equation for calculating the estimated glomerular filtration rate (GFR).

OBJECTIVE

The purpose of this article was to compare the use of this estimated GFR with estimated creatinine clearance (CrCl) calculated using the Cockcroft-Gault equation (CG(CrCl)-Eq) in the dosing of drugs requiring adjustments in elderly patients with declining renal function. Existing as well as new serum creatinine assay standards were used.

METHODS

A PubMed literature search for all English-language articles published before November 2007 was conducted using the terms estimated glomerular filtration, GFR, modified diet in renal disease, MDRD, creatinine clearance, CrCl, drug dosing adjustment, renal impairment, human, and elderly. Mathematical comparisons of the age, race, and sex factors for these 2 equations (CG(CrCl)-Eq and MDRD) were performed, as well as a simulation of resulting values from these equations using various combinations of age, weight, and sex factors.

RESULTS

None of the articles identified found that the use of the MDRD equation in the elderly was better than the CG(CrCl)-Eq for estimating renal drug elimination. Substantial mathematical differences are inherent in these 2 prediction equations that make any clinical comparison quite difficult. Implementation of new creatinine assay standards will further confuse the use of these 2 equations for estimating GFR and for dosage adjustments in elderly patients with renal insufficiency.

CONCLUSIONS

Although an MDRD equation may be useful for estimating GFR, the CG(CrCl)-Eq should still be used for drug dosage adjustments. The CG(CrCl)-Eq may require a slight "adjustment factor" to be applied using serum creatinine values measured by newly established assay procedures.

Authors+Show Affiliations

Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia 30602-2354, USA. bspruill@mail.rx.uga.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18775390

Citation

Spruill, William J., et al. "Comparison of Estimated Glomerular Filtration Rate With Estimated Creatinine Clearance in the Dosing of Drugs Requiring Adjustments in Elderly Patients With Declining Renal Function." The American Journal of Geriatric Pharmacotherapy, vol. 6, no. 3, 2008, pp. 153-60.
Spruill WJ, Wade WE, Cobb HH. Comparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function. Am J Geriatr Pharmacother. 2008;6(3):153-60.
Spruill, W. J., Wade, W. E., & Cobb, H. H. (2008). Comparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function. The American Journal of Geriatric Pharmacotherapy, 6(3), 153-60. https://doi.org/10.1016/j.amjopharm.2008.07.002
Spruill WJ, Wade WE, Cobb HH. Comparison of Estimated Glomerular Filtration Rate With Estimated Creatinine Clearance in the Dosing of Drugs Requiring Adjustments in Elderly Patients With Declining Renal Function. Am J Geriatr Pharmacother. 2008;6(3):153-60. PubMed PMID: 18775390.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function. AU - Spruill,William J, AU - Wade,William E, AU - Cobb,Henry H,3rd PY - 2008/04/03/accepted PY - 2008/9/9/pubmed PY - 2008/10/24/medline PY - 2008/9/9/entrez SP - 153 EP - 60 JF - The American journal of geriatric pharmacotherapy JO - Am J Geriatr Pharmacother VL - 6 IS - 3 N2 - BACKGROUND: The National Kidney Foundation's practice guidelines for chronic kidney disease recommend using the Modification of Diet in Renal Disease (MDRD) equation for calculating the estimated glomerular filtration rate (GFR). OBJECTIVE: The purpose of this article was to compare the use of this estimated GFR with estimated creatinine clearance (CrCl) calculated using the Cockcroft-Gault equation (CG(CrCl)-Eq) in the dosing of drugs requiring adjustments in elderly patients with declining renal function. Existing as well as new serum creatinine assay standards were used. METHODS: A PubMed literature search for all English-language articles published before November 2007 was conducted using the terms estimated glomerular filtration, GFR, modified diet in renal disease, MDRD, creatinine clearance, CrCl, drug dosing adjustment, renal impairment, human, and elderly. Mathematical comparisons of the age, race, and sex factors for these 2 equations (CG(CrCl)-Eq and MDRD) were performed, as well as a simulation of resulting values from these equations using various combinations of age, weight, and sex factors. RESULTS: None of the articles identified found that the use of the MDRD equation in the elderly was better than the CG(CrCl)-Eq for estimating renal drug elimination. Substantial mathematical differences are inherent in these 2 prediction equations that make any clinical comparison quite difficult. Implementation of new creatinine assay standards will further confuse the use of these 2 equations for estimating GFR and for dosage adjustments in elderly patients with renal insufficiency. CONCLUSIONS: Although an MDRD equation may be useful for estimating GFR, the CG(CrCl)-Eq should still be used for drug dosage adjustments. The CG(CrCl)-Eq may require a slight "adjustment factor" to be applied using serum creatinine values measured by newly established assay procedures. SN - 1543-5946 UR - https://www.unboundmedicine.com/medline/citation/18775390/Comparison_of_estimated_glomerular_filtration_rate_with_estimated_creatinine_clearance_in_the_dosing_of_drugs_requiring_adjustments_in_elderly_patients_with_declining_renal_function_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1543-5946(08)00037-8 DB - PRIME DP - Unbound Medicine ER -