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Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index
An accurate estimated glomerular filtration rate (eGFR) is essential in drug dosing. This study demonstrates the limitations of indexed (ml/min/1.73 m(2)) and de‐indexed (ml/min) eGFR based drug dosing in patients with obesity or underweight. This systematic study aimed to determine the most appropr...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9468571/ https://www.ncbi.nlm.nih.gov/pubmed/35751390 http://dx.doi.org/10.1111/cts.13354 |
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author | Donker, Erik M. Bet, Pierre Nurmohamed, Azam Serné, Erik Burchell, George Louis Friedman, Allon N. Bouquegneau, Antoine Lemoine, Sandrine Ebert, Natalie Cirillo, Massimo van Agtmael, Michiel A. Bartelink, Imke H. |
author_facet | Donker, Erik M. Bet, Pierre Nurmohamed, Azam Serné, Erik Burchell, George Louis Friedman, Allon N. Bouquegneau, Antoine Lemoine, Sandrine Ebert, Natalie Cirillo, Massimo van Agtmael, Michiel A. Bartelink, Imke H. |
author_sort | Donker, Erik M. |
collection | PubMed |
description | An accurate estimated glomerular filtration rate (eGFR) is essential in drug dosing. This study demonstrates the limitations of indexed (ml/min/1.73 m(2)) and de‐indexed (ml/min) eGFR based drug dosing in patients with obesity or underweight. This systematic study aimed to determine the most appropriate approach to estimate the GFR for standardized eGFR based drug dosing in these patients. (Raw) data of 12 studies were selected to investigate the accuracy and bias of both the indexed and de‐indexed estimations of the Modification of Diet in Renal Disease (MDRD) study equation and the Chronic Kidney Disease Epidemiology Collaboration equation (CKD‐EPI), and of the Cockcroft–Gault (CG) in patients with obesity or underweight. Accuracy was calculated as the proportion of eGFR values within 30% of the measured GFR (P30) using an inert tracer (e.g., iohexol, inulin, (51)Cr‐EDTA, or iothalamate clearance). An accuracy of at least 80% was considered acceptable. GFR values estimated with the CG, MDRD, and CKD‐EPI differ significantly within a patient with obesity or underweight regardless of whether it is indexed or de‐indexed. All studies, with two exceptions, show that all three equations are inaccurate for patients with underweight or class II obesity (P30: 55%–94%). De‐indexing eGFR improves not or modestly the accuracy, and mostly remains below the 80% (P30: 62%–100%). CG was highly inaccurate in obese and underweight patients (P30: 7%–82%). Although these results show that CG is obsolete, the accuracy of MDRD and CKD‐EPI is low in patients with obesity or underweight and de‐indexing is not the solution. Better education and more accurate methods for appropriate drug dosing (e.g., measured GFR with inert tracer, therapeutic drug monitoring, or 24‐h creatinine clearance) are recommended. |
format | Online Article Text |
id | pubmed-9468571 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-94685712022-09-27 Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index Donker, Erik M. Bet, Pierre Nurmohamed, Azam Serné, Erik Burchell, George Louis Friedman, Allon N. Bouquegneau, Antoine Lemoine, Sandrine Ebert, Natalie Cirillo, Massimo van Agtmael, Michiel A. Bartelink, Imke H. Clin Transl Sci Research An accurate estimated glomerular filtration rate (eGFR) is essential in drug dosing. This study demonstrates the limitations of indexed (ml/min/1.73 m(2)) and de‐indexed (ml/min) eGFR based drug dosing in patients with obesity or underweight. This systematic study aimed to determine the most appropriate approach to estimate the GFR for standardized eGFR based drug dosing in these patients. (Raw) data of 12 studies were selected to investigate the accuracy and bias of both the indexed and de‐indexed estimations of the Modification of Diet in Renal Disease (MDRD) study equation and the Chronic Kidney Disease Epidemiology Collaboration equation (CKD‐EPI), and of the Cockcroft–Gault (CG) in patients with obesity or underweight. Accuracy was calculated as the proportion of eGFR values within 30% of the measured GFR (P30) using an inert tracer (e.g., iohexol, inulin, (51)Cr‐EDTA, or iothalamate clearance). An accuracy of at least 80% was considered acceptable. GFR values estimated with the CG, MDRD, and CKD‐EPI differ significantly within a patient with obesity or underweight regardless of whether it is indexed or de‐indexed. All studies, with two exceptions, show that all three equations are inaccurate for patients with underweight or class II obesity (P30: 55%–94%). De‐indexing eGFR improves not or modestly the accuracy, and mostly remains below the 80% (P30: 62%–100%). CG was highly inaccurate in obese and underweight patients (P30: 7%–82%). Although these results show that CG is obsolete, the accuracy of MDRD and CKD‐EPI is low in patients with obesity or underweight and de‐indexing is not the solution. Better education and more accurate methods for appropriate drug dosing (e.g., measured GFR with inert tracer, therapeutic drug monitoring, or 24‐h creatinine clearance) are recommended. John Wiley and Sons Inc. 2022-07-02 2022-09 /pmc/articles/PMC9468571/ /pubmed/35751390 http://dx.doi.org/10.1111/cts.13354 Text en © 2022 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Research Donker, Erik M. Bet, Pierre Nurmohamed, Azam Serné, Erik Burchell, George Louis Friedman, Allon N. Bouquegneau, Antoine Lemoine, Sandrine Ebert, Natalie Cirillo, Massimo van Agtmael, Michiel A. Bartelink, Imke H. Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index |
title | Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index |
title_full | Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index |
title_fullStr | Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index |
title_full_unstemmed | Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index |
title_short | Estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index |
title_sort | estimation of glomerular filtration rate for drug dosing in patients with very high or low body mass index |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9468571/ https://www.ncbi.nlm.nih.gov/pubmed/35751390 http://dx.doi.org/10.1111/cts.13354 |
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