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The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury

BACKGROUND: In acute kidney injury (AKI), medication dosing based on Cockcroft-Gault creatinine clearance (CrCl) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rates (eGFR) are not valid when serum creatinine (SCr) is not in steady state. The aim of th...

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Autores principales: Kwong, Yuenting D., Chen, Sheldon, Bouajram, Rima, Li, Fanny, Matthay, Michael A., Mehta, Kala M., Glidden, David V., Liu, Kathleen D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879155/
https://www.ncbi.nlm.nih.gov/pubmed/31770424
http://dx.doi.org/10.1371/journal.pone.0225601
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author Kwong, Yuenting D.
Chen, Sheldon
Bouajram, Rima
Li, Fanny
Matthay, Michael A.
Mehta, Kala M.
Glidden, David V.
Liu, Kathleen D.
author_facet Kwong, Yuenting D.
Chen, Sheldon
Bouajram, Rima
Li, Fanny
Matthay, Michael A.
Mehta, Kala M.
Glidden, David V.
Liu, Kathleen D.
author_sort Kwong, Yuenting D.
collection PubMed
description BACKGROUND: In acute kidney injury (AKI), medication dosing based on Cockcroft-Gault creatinine clearance (CrCl) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rates (eGFR) are not valid when serum creatinine (SCr) is not in steady state. The aim of this study was to determine the impact of a kinetic estimating equation that incorporates fluctuations in SCrs on drug dosing in critically ill patients. METHODS: We used data from participants enrolled in the NIH Acute Respiratory Distress Syndrome Network Fluid and Catheters Treatment Trial to simulate drug dosing category changes with the application of the kinetic estimating equation developed by Chen. We evaluated whether kinetic estimation of renal function would change medication dosing categories (≥60, 30–59, 15–29, and <15mL/min) compared with the use of CrCl or CKD-EPI eGFR. RESULTS: The use of kinetic CrCl and CKD-EPI eGFR resulted in a large enough change in estimated renal function to require medication dosing recategorization in 19.3% [95 CI 16.8%–21.9%] and 23.4% [95% CI 20.7%–26.1%] of participants, respectively. As expected, recategorization occurred more frequently in those with AKI. When we examined individual days for those with AKI, dosing discordance was observed in 8.5% of total days using the CG CrCl and 10.2% of total days using the CKD-EPI equation compared with the kinetic counterparts. CONCLUSION: In a critically ill population, use of kinetic estimates of renal function impacted medication dosing in a substantial proportion of AKI participants. Use of kinetic estimates in clinical practice should lower the incidence of medication toxicity as well as avoid subtherapeutic dosing during renal recovery.
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spelling pubmed-68791552019-12-08 The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury Kwong, Yuenting D. Chen, Sheldon Bouajram, Rima Li, Fanny Matthay, Michael A. Mehta, Kala M. Glidden, David V. Liu, Kathleen D. PLoS One Research Article BACKGROUND: In acute kidney injury (AKI), medication dosing based on Cockcroft-Gault creatinine clearance (CrCl) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rates (eGFR) are not valid when serum creatinine (SCr) is not in steady state. The aim of this study was to determine the impact of a kinetic estimating equation that incorporates fluctuations in SCrs on drug dosing in critically ill patients. METHODS: We used data from participants enrolled in the NIH Acute Respiratory Distress Syndrome Network Fluid and Catheters Treatment Trial to simulate drug dosing category changes with the application of the kinetic estimating equation developed by Chen. We evaluated whether kinetic estimation of renal function would change medication dosing categories (≥60, 30–59, 15–29, and <15mL/min) compared with the use of CrCl or CKD-EPI eGFR. RESULTS: The use of kinetic CrCl and CKD-EPI eGFR resulted in a large enough change in estimated renal function to require medication dosing recategorization in 19.3% [95 CI 16.8%–21.9%] and 23.4% [95% CI 20.7%–26.1%] of participants, respectively. As expected, recategorization occurred more frequently in those with AKI. When we examined individual days for those with AKI, dosing discordance was observed in 8.5% of total days using the CG CrCl and 10.2% of total days using the CKD-EPI equation compared with the kinetic counterparts. CONCLUSION: In a critically ill population, use of kinetic estimates of renal function impacted medication dosing in a substantial proportion of AKI participants. Use of kinetic estimates in clinical practice should lower the incidence of medication toxicity as well as avoid subtherapeutic dosing during renal recovery. Public Library of Science 2019-11-26 /pmc/articles/PMC6879155/ /pubmed/31770424 http://dx.doi.org/10.1371/journal.pone.0225601 Text en © 2019 Kwong et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kwong, Yuenting D.
Chen, Sheldon
Bouajram, Rima
Li, Fanny
Matthay, Michael A.
Mehta, Kala M.
Glidden, David V.
Liu, Kathleen D.
The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
title The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
title_full The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
title_fullStr The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
title_full_unstemmed The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
title_short The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
title_sort value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879155/
https://www.ncbi.nlm.nih.gov/pubmed/31770424
http://dx.doi.org/10.1371/journal.pone.0225601
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