Evaluation and enhancement of standard equations for renal function estimation in individuals with components of metabolic disease

Brunetti, Luigi; Back, Hyun-moon; Yu, Sijia; Jalil, Urma; Kagan, Leonid

doi:10.1186/s12882-021-02588-4

Cited by 6 publications

(7 citation statements)

References 41 publications

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“…There is no current agreement as to the best method to estimate the GFR in individuals with severe obesity. However, in a recently reported study [12], the modified Cockcroft-Gault (CG) equation performed best in both the overall population and the obese subgroup in terms of strength of correlation, mean bias and accuracy, as compared to both the IDMS (isotope dilution mass spectrometry) traceable simplified Modification of Diet in Renal Disease [13] and the Chronic Kidney Disease-Epidemiology Collaborative equations [14]. We obtained equivalent results to that report.…”

Section: Serum Creatinine and Egfrsupporting

confidence: 61%

Exploring Renal Changes after Bariatric Surgery in Patients with Severe Obesity

Oliveras

Vázquez

Soler

et al. 2022

JCM

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Obesity-related hyperfiltration leads to an increased glomerular filtration rate (GFR) and hyperalbuminuria. These changes are reversible after bariatric surgery (BS). We aimed to explore obesity-related renal changes post-BS and to seek potential mechanisms. Sixty-two individuals with severe obesity were prospectively examined before and 3, 6 and 12 months post-BS. Anthropometric and laboratory data, 24 h-blood pressure, renin-angiotensin-aldosterone system (RAS) components, adipokines and inflammatory markers were determined. Both estimated GFR (eGFR) and albuminuria decreased from the baseline at all follow-up times (p-for-trend <0.001 for both). There was a median (IQR) of 30.5% (26.2–34.4) reduction in body weight. Plasma glucose, glycosylated hemoglobin, fasting insulin and HOMA-index decreased at 3, 6 and 12 months of follow-up (p-for-trend <0.001 for all). The plasma aldosterone concentration (median (IQR)) also decreased at 12 months (from 87.8 ng/dL (56.8; 154) to 65.4 (56.8; 84.6), p = 0.003). Both leptin and hs-CRP decreased (p < 0.001) and adiponectine levels increased at 12 months post-BS (p = 0.017). Linear mixed-models showed that body weight (coef. 0.62, 95% CI: 0.32 to 0.93, p < 0.001) and plasma aldosterone (coef. −0.07, 95% CI: −0.13 to −0.02, p = 0.005) were the independent variables for changes in eGFR. Conversely, glycosylated hemoglobin was the only independent variable for changes in albuminuria (coef. 0.24, 95% CI: 0.06 to 0.42, p = 0.009). In conclusion, body weight and aldosterone are the main factors that mediate eGFR changes in obesity and BS, while albuminuria is associated with glucose homeostasis.

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Section: Serum Creatinine and Egfrsupporting

confidence: 61%

Exploring Renal Changes after Bariatric Surgery in Patients with Severe Obesity

Oliveras

Vázquez

Soler

et al. 2022

JCM

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“…However, Cockcroft and Gault identified that patients who were obese excreted less creatinine per kilogram body weight than expected. This promoted the idea that using lean or adjusted body weight may be beneficial in CG instead of actual body weight for obese individuals 2,5,8 . Ideal body weight (IBW) was developed to estimate lean body weight or “fat free” mass.…”

Section: Introductionmentioning

confidence: 99%

“…This promoted the idea that using lean or adjusted body weight may be beneficial in CG instead of actual body weight for obese individuals. 2,5,8 Ideal body weight (IBW) was developed to estimate lean body weight or "fat free" mass. Adjusted body weight was developed to incorporate the additional body mass and renal flow rate present in obese patients without the overestimation that total body weight (TBW) provides.…”

Section: Introductionmentioning

confidence: 99%

“…Ideal body weight (IBW) was developed to estimate lean body weight or “fat free” mass. Adjusted body weight was developed to incorporate the additional body mass and renal flow rate present in obese patients without the overestimation that total body weight (TBW) provides 2,8,9 . Additionally, there is a discordance of evidence regarding the threshold of weight or obesity where adjusted body weight should be utilized.…”

Section: Introductionmentioning

confidence: 99%

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Impact of weight and creatinine adjustments on the accuracy of Cockcroft‐gault equation in hematopoietic cell transplant patients

Emanuel

Price

Hansen

et al. 2023

Clinical Transplantation

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BackgroundHematopoietic cell transplant (HCT) patients undergo pre‐ transplant renal function evaluation to confirm transplant eligibility and tailor pharmacotherapy. There is limited evidence regarding the most accurate method of estimating creatinine clearance (CrCl) within this patient population and no studies exist that evaluate the weight utilized within the Cockcroft‐Gault (CG) equation in HCT patients. This study evaluates different weight and serum creatinine (SCr) adjustments utilized within the CG equation estimating for renal clearance in patients undergoing HCT.ObjectiveThis is a retrospective, single center analysis of adult HCT patients who underwent pre‐transplant evaluation with a measured CrCl using a 24‐h urine creatinine collection. The primary outcome was to evaluate the correlation of various weights used in estimation of CrCl compared to measured CrCl. Key secondary outcomes include evaluation of the impact of various weights on estimated CrCl in subpopulations, evaluation of adjusting SCr to pre‐determined limits, and determination of an appropriate obesity threshold to utilize body weight adjustments.ResultsSeven‐hundred and forty‐two patients were included in the study. In the primary analysis, CG utilizing adjusted body weight (ADjBW0.4) had a greater correlation (r = .812) to measured CrCl when compared to total or ideal body weight (r = .801 and r = .790 respectively). The threshold of 120% of ideal body weight (IBW) produced less bias and greater accuracy in comparison to the threshold of 140% IBW. In patients 60 years or older, rounding low SCr values up .8 or 1 mg/dL resulted in decreased correlation and a greater mean difference in comparison to not rounding SCr.ConclusionIn HCT patients who are overweight or obese, ADjBW .4 is the most accurate weight for the CG equation. In HCT patients who have a total body weight < 120% IBW, total body weight is the most accurate weight to utilize. Rounding up low SCr to .8 or 1 mg/dL does not improve the accuracy or led to less bias of the CG equation.

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“…A reduction in dose intensity may risk therapeutic failure. Of course, measurement of serum creatinine is subject to both circadian variability 8 and significant intra‐ and interlaboratory assay error 9 as well as known issues with equations used to approximate CLCR, 10 which risks misclassification of patients into dose bands based on variation in measurement of creatinine clearance rather than variation in glomerular filtration rate.…”

Section: Introductionmentioning

confidence: 99%

Dose banding – Weighing up benefits, risks and therapeutic failure

Duffull

2022

Brit J Clinical Pharma

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Aims Dose banding is a method of dose individualisation in which all patients with similar characteristics are allocated to the same dose. Dose banding results in some patients receiving less intensive treatment which risks a reduction in therapeutic benefit (iatrogenic therapeutic failure) because of variability not predicted by dose banding. This study aims to explore the effects of dose banding on therapeutic success and failure. Methods This was a simulation study. Virtual patients were simulated under a simple pharmacokinetic model where the response of interest is the steady‐state average concentration. Clearance was correlated with a covariate used for dose banding. Dose individualisation was based on: one‐dose‐fits‐all, covariate‐based dosing, empirical dose banding, dose banding optimised for net therapeutic benefit and optimised for both benefit and minimising iatrogenic therapeutic failure. Results The lowest and highest probability of target attainment (PTA) were 44% for one‐dose‐fits‐all and 72% for covariate‐based dosing. Neither dosing approach would result in iatrogenic therapeutic failure as lower dose intensities do not occur. Empirical dose banding performed better than one‐dose‐fits‐all with 59% PTA but not as good as either optimised method (64–69% PTA) while carrying a risk of iatrogenic therapeutic failure in 25% of patients. Optimising for benefit (only) improved PTA but carried a risk of iatrogenic therapeutic failure of up to 10%. Optimising for benefit and minimising iatrogenic therapeutic failure provided the best balance. Conclusion Future application of dose banding needs to consider both the probability of benefit as well the risk of causing iatrogenic therapeutic failure.

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Evaluation and enhancement of standard equations for renal function estimation in individuals with components of metabolic disease

Cited by 6 publications

References 41 publications

Exploring Renal Changes after Bariatric Surgery in Patients with Severe Obesity

Exploring Renal Changes after Bariatric Surgery in Patients with Severe Obesity

Impact of weight and creatinine adjustments on the accuracy of Cockcroft‐gault equation in hematopoietic cell transplant patients

Dose banding – Weighing up benefits, risks and therapeutic failure

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