Removal of body surface area normalisation improves raw‐measured glomerular filtration rate estimation by the Chronic Kidney Disease Epidemiology Collaboration equation and drug dosing in the obese

Chew-Harris, Janice; Chin, Paul; Florkowski, Chris; George, Peter M.; Endre, Zoltán H.

doi:10.1111/imj.12791

Cited by 24 publications

(16 citation statements)

References 38 publications

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“…However, de‐indexation is crucial because the performance of the CKD‐EPI equation (in ml min –1 1.73 m –2 ) compared with the non‐indexed mGFR equations (ml min –1 ) is significantly worse, and underestimates the mGFR more (data not shown). The same results have been demonstrated in a recent study by Chew‐Harris et al . In this study, only 78 obese patients were included but the authors showed that the CKD‐EPI without normalization (in ml min −1 ) was superior to the CKD‐EPI equation indexed (in ml min −1 1.73 m –2 ) in estimating the absolute clearance of 99 mTc‐DTPA (in ml min −1 ).…”

Section: Discussionsupporting

confidence: 84%

Creatinine‐based equations for the adjustment of drug dosage in an obese population

Bouquegneau

Vidal‐Petiot

Moranne³

et al. 2016

Brit J Clinical Pharma

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AIMFor drug dosing adaptation, the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend using estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, after 'de-indexation' by body surface area (BSA). In pharmacology, the Cockcroft-Gault (CG) equation is still recommended to adapt drug dosage. In the context of obesity, adjusted ideal body weight (AIBW) is sometimes preferred to actual body weight (ABW) for the CG equation. The aim of the present study was to compare the performance of the different GFR-estimating equations, non-indexed or de-indexed by BSA for the purpose of drugdosage adaptation in obese patients. METHODSWe analysed data from patients with a body mass index (BMI) higher than 30 kg m À2 who underwent a GFR measurement. eGFR was calculated using the CKD-EPI and Modification of Diet in Renal Disease (MDRD) equations, de-indexed by BSA, and the CG equation, using either ABW, AIBW or lean body weight (LBW) for the weight variable and compared with measured GFR, expressed in ml min À1 . RESULTSIn our population of obese patients, use of the AIBW instead of the ABW in the CG equation, markedly improved the overall accuracy of this equation [57% for CG ABW and 79% for CG AIBW (P < 0.05)]. For high BMI (over 40 kg m À2 ), the accuracy of the CG equations is no different when using LBW than when using AIBW. The MDRD and CKD-EPI equations de-indexed by the BSA also performed well, with an overall higher accuracy for the MDRD de-indexed equation [(80% and 76%, respectively (P < 0.05)]. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• For the purpose of chronic kidney disease follow-up, the CG equation is no longer recommended and GFR should be estimated using the creatinine-derived MDRD or CKD EPI equations and expressed in ml min À1 1.73 m -2 . We have recently shown that both equations perform similarly in a population of obese patients. For the specific issue of drug dose adaptation, thresholds of GFR are given in ml min À1 , and most authors recommend using the CG equation, although others recommend using the MDRD or CKD-EPI equation with de-indexation of the GFR result. Very few data are available, especially in obese patients, to recommend which is the best strategy.

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Section: Discussionsupporting

confidence: 84%

Creatinine‐based equations for the adjustment of drug dosage in an obese population

Bouquegneau

Vidal‐Petiot

Moranne³

et al. 2016

Brit J Clinical Pharma

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“…This finding is consistent with the previous literature, which demonstrated that the CKD‐EPI equation non‐normalized to the BSA correlated more closely with the Cockcroft‐Gault equation than did other formulae . Similarly, in another study, the non‐normalized CKD‐EPI equation (mL/min) was found superior to the normalized CKD‐EPI equation in estimating GFR (mL/min per 1.73 m 2 ) for drug dosing . Using the GFR (mL/min) as the reference for dosing, the CKD‐EPI with the removal of BSA normalization (mL/min) was associated with greater dosing concordance of carboplatin .…”

Section: Discussionmentioning

confidence: 90%

“…35 Similarly, in another study, the non-normalized CKD-EPI equation (mL/ min) was found superior to the normalized CKD-EPI equation in estimating GFR (mL/min per 1.73 m 2 ) for drug dosing. 36 Using the GFR (mL/min) as the reference for dosing, the CKD-EPI with the removal of BSA normalization (mL/min) was associated with greater dosing concordance of carboplatin. 36 The non-normalized CKD-EPI (mL/min) provided results, which were less biassed and comparable at predicting GFR (mL/min) at higher levels of GFR and body mass index.…”

Section: Discussionmentioning

confidence: 96%

“…36 Using the GFR (mL/min) as the reference for dosing, the CKD-EPI with the removal of BSA normalization (mL/min) was associated with greater dosing concordance of carboplatin. 36 The non-normalized CKD-EPI (mL/min) provided results, which were less biassed and comparable at predicting GFR (mL/min) at higher levels of GFR and body mass index. 37,38 A possible explanation for these findings would be that in this and the previously mentioned studies, the mean BSA for the sample was about 2 m 2 .…”

Section: Discussionmentioning

confidence: 96%

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Comparison of equations for dosing of medications in renal impairment

et al. 2017

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There is need for a long-term multi-centre study in a diverse population to define the clinical effects of the discrepancies among the equations for drug dosing. Given the greater concordance of the non-normalized CKD-EPI equation with the Cockcroft-Gault equation for dosing, the recommendation by Kidney Health Australia and the United States National Kidney Disease Education Program that 'dosing based on either eCrCl or an eGFR with body surface area normalization removed are acceptable' seems suitable and practicable for the purpose of dosing of non-critical drugs in the primary care setting.

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“…Renal function was assessed using serum creatinine and estimated glomerular filtration rate by the CKD‐EPI formula (Levey et al ., ). Additionally, the CKD‐EPI without adjustment for body surface area (BSA) was calculated, as it improves accuracy of eGFR in obese subjects (Chew‐Harris et al ., ). As there was no association of the aforementioned baseline renal function parameters with baseline CAF (Figure S1), all participants were included in the analytic sample.…”

Section: Methodsmentioning

confidence: 97%

Testosterone does not affect agrin cleavage in mobility‐limited older men despite improvement in physical function

et al. 2017

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In a subset of men, sarcopenia and physical dysfunction occur due to destabilization of the neuromuscular junction (NMJ), which is manifested by elevated serum concentrations of C-terminal agrin fragment (CAF). Testosterone administration improves physical function in some studies; however, its effects on serum circulating CAF concentrations remain unknown. Here we evaluate the effects of testosterone administration on circulating CAF levels in mobility-limited men with low testosterone aged 65 or older participating in the Testosterone in Older Men with Mobility Limitations (TOM) Trial. We analyzed the difference in change in serum CAF levels between testosterone and placebo groups, as well as its association with muscle strength and physical function. Association of change in serum CAF levels with serum total (TT) and free testosterone (FT) was also evaluated. Men randomized to testosterone experienced significant improvement in muscle strength and physical function (assessed by loaded stair-climbing power). However; testosterone administration was not associated with a reduction in serum CAF levels (effect size = -50.3 pm; 95% CI = -162.1 to 61.5 pm; p = 0.374); there was no association between changes in CAF levels with changes in TT (p = 0.670) or FT (p = 0.747). There was no association between changes in serum CAF levels with improvement in either muscle strength or stair-climbing power. In conclusion, testosterone treatment in mobility-limited older men with low to low-normal testosterone levels did not reduce serum CAF levels. Additionally, testosterone-induced improvements in muscle strength and physical function were not associated with changes in serum CAF concentrations. These findings suggest that improvement in physical function with testosterone replacement in older men with mobility limitations and elevated CAF levels is mediated by mechanisms other than stabilization of the NMJ.

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Removal of body surface area normalisation improves raw‐measured glomerular filtration rate estimation by the Chronic Kidney Disease Epidemiology Collaboration equation and drug dosing in the obese

Abstract: The CKD-EPI without normalisation (CKD-EPI_noBSA) equation was superior to the CKD-EPI equation in estimating raw-measured Tc-DTPA GFR (mL/min).

Cited by 24 publications

References 38 publications

Creatinine‐based equations for the adjustment of drug dosage in an obese population

Creatinine‐based equations for the adjustment of drug dosage in an obese population

Comparison of equations for dosing of medications in renal impairment

Testosterone does not affect agrin cleavage in mobility‐limited older men despite improvement in physical function

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