Clearance Confusion: An Exploratory Analysis of Inpatient Dosing Discordances Between Renal Estimating Equations

McConachie, Sean; Shammout, Laila; Martirosov, Dmitriy M.

doi:10.1177/1060028020922492

Cited by 7 publications

(10 citation statements)

References 31 publications

(55 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both equations are now necessary for medication dose modification because an increasing number of medications have been approved in recent years with labeling recommending dose adjustment by CKD-EPI or MDRD in lieu of the more traditional C-G. 7,11 Unfortunately, studies that analyze dose discordance rates between the variants of the C-G equation and the 2 GFR equations suggest prevalence rates as high as 40%, and discordance rates appear to be particularly high in the elderly. 18,29,30,31 Further research is necessary before the use of a single equation is adopted by the pharmaceutical industry or medical practitioners. Simultaneously, further research into the way that multiple estimates affect clinical decision-making may have the potential to improve the way EMRs affect renal dosing decisions in inpatient settings.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Multiple Renal Estimates on Pharmacist Dosing Recommendations: A Randomized Trial

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Numerous equations are used for estimation of renal function, and many electronic medical records report multiple clearance estimates to assist with drug dosing. It is unknown whether the presence of multiple clearance estimates affects clinical decision-making. Objective: To determine whether the presence of multiple renal clearance estimates affects pharmacist drug dosing decisions. Methods: A randomized trial in the form of an electronic survey including 4 clinical vignettes was delivered to hospital pharmacists. Vignettes consisted of a patient presenting with an acute pulmonary embolism requiring enoxaparin therapy. Pharmacists were randomized to receive a single estimate of renal function or multiple estimates for all vignettes. The primary outcome was deviation from approved recommendations on at least 1 vignette. The χ2 test was used to detect differences in deviation rates between groups. Logistic regression was performed to adjust for the effects of potentially confounding variables. Results: A total of 154 studies were completed (73 in the multiple-estimate group and 81 in the single-estimate group). Pharmacists presented with multiple renal estimates were significantly more likely to deviate from recommended dosing regimens than pharmacists presented with a single estimate (54.7% vs 38.2%; P = 0.04). The results were driven primarily by the 2 vignettes that included discordance among Cockcroft-Gault equation creatinine clearance estimates. Logistic regression identified multiple estimates as the only independent predictor of deviation ( P = 0.04). Conclusion and Relevance: Pharmacists provided with a single renal clearance estimate were more likely to adhere to approved dosing recommendations than pharmacists provided with multiple estimates.

show abstract

Section: Discussionmentioning

confidence: 99%

The Impact of Multiple Renal Estimates on Pharmacist Dosing Recommendations: A Randomized Trial

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…information, the reader is referred to a recent paper 19 that found a widespread dosing discordance rate between the CG, MDRD and CKD-EPI equations in patients.…”

Section: Accepted Articlementioning

confidence: 99%

“…Using the CKD‐EPI equation for measuring GFR in phase I studies may help in harmonizing CKD staging, population PK (PopPK) analyses, and dosing by estimated renal function. 18 For more information, the reader is referred to a recent paper 19 that found a widespread dosing discordance rate among the CG, MDRD, and CKD‐EPI equations in patients.…”

Section: Assessment Of Renal Functionmentioning

confidence: 99%

Design and conduct considerations for studies in patients with impaired renal function

Ravenstijn¹,

Chetty

Manchandani

2021

Clinical Translational Sci

View full text Add to dashboard Cite

An impaired renal function, including acute and chronic kidney disease and end-stage renal disease (ESRD), can be the result of ageing, certain disease conditions, the use of some medications or as a result of smoking. In patients with renal impairment (RI), the pharmacokinetics (PK) of drugs or drug metabolites may change and result in increased safety risks or decreased efficacy. In order to make specific dose recommendations in the label of drugs for RI patients, a clinical trial may have to be conducted or, when not feasible, modelling and simulations approaches such as population PK modelling (PopPK) or physiologically-based PK (PBPK) modelling may be applied. This tutorial aims to provide an overview of the global regulatory landscape and a practical guidance for successfully designing and conducting clinical RI trials or, alternatively, on applying modelling and simulation tools to come to a dose recommendation for RI patient in the most efficient manner.

show abstract

“…Numerous research studies have indicated that significant differences exist when comparing CG CrCl and the GFR equations when estimating renal function for the purposes of making dosage adjustments. 9,10 Discordance with drug dosage recommendations have been reported in rates ranging from 20% to 67% when comparing MDRD estimated GFR (eGFR) to CrCl. 11 Despite this, the National Institute of Diabetes and Digestive and Kidney Diseases Laboratory Working Group recommends eGFR as an alternative to CrCl for drug dosing, and several recently approved medications include dosage recommendations based on eGFR.…”

Section: Introductionmentioning

confidence: 99%

Impact of Removing the Race Coefficient in Renal Function Estimate Equations on Drug Dosage Recommendations

Miller

Knorr

2021

Ann Pharmacother

View full text Add to dashboard Cite

Background The appropriateness of including the race coefficient in glomerular filtration rate (GFR) equations in Black patients is debated, and the impact on drug dosing is unknown. Objective This study explored the impact of removing the race coefficient on drug dosing in Black patients in comparison to conventional methods. Methods This was a retrospective study of hospitalized patients who self-identified as Black/African American and were prescribed an antimicrobial that includes renal dosage recommendations in the product labeling. The primary end point was the discordance between drug dosing recommendations derived by body surface area deindexed GFR estimated by the CKD-EPI equation (Chronic Kidney Disease Epidemiology study) with and without race versus recommendations derived from Cockcroft-Gault (CG). Results A total of 210 Black patients were included. There was an 18% rate of discordance when GFR was estimated with the race coefficient (GFR w/Race) versus without the race coefficient (GFR w/out Race). GFR w/out Race had a higher level of agreement with dosing by creatinine clearance (CrCl; κ = 0.779) than GFR w/Race versus CrCl (κ = 0.651). GFR w/out Race had less within-patient difference than GFR w/Race in comparison to CrCl (mean difference: −6.3 vs −18.0 mL/min). Conclusions and Relevance This represents the first report to examine the removal of the race coefficient and its implication on drug dose discordance. GFR w/out Race had a higher level of agreement and less drug dose discordance than GFR w/Race, in comparison to CrCl estimates. If GFR equations are considered comparable to CrCl for the purposes of guiding drug dosing, GFR w/out Race should be considered.

show abstract

Clearance Confusion: An Exploratory Analysis of Inpatient Dosing Discordances Between Renal Estimating Equations

Cited by 7 publications

References 31 publications

The Impact of Multiple Renal Estimates on Pharmacist Dosing Recommendations: A Randomized Trial

The Impact of Multiple Renal Estimates on Pharmacist Dosing Recommendations: A Randomized Trial

Design and conduct considerations for studies in patients with impaired renal function

Impact of Removing the Race Coefficient in Renal Function Estimate Equations on Drug Dosage Recommendations

Contact Info

Product

Resources

About