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Performance of creatinine-based equations to estimate glomerular filtration rate with a methodology adapted to the context of drug dosage adjustment

Delanaye, Pierre ; Björk, Jonas LU ; Courbebaisse, Marie ; Couzi, Lionel ; Ebert, Natalie ; Eriksen, Björn O. ; Dalton, R. Neil ; Dubourg, Laurence ; Gaillard, Francois and Garrouste, Cyril , et al. (2022) In British Journal of Clinical Pharmacology 88(5). p.2118-2127
Abstract

Aim: The Cockcroft-Gault (CG) creatinine-based equation is still used to estimate glomerular filtration rate (eGFR) for drug dosage adjustment. Incorrect eGFR may lead to hazardous over- or underdosing. Methods: In a cross-sectional analysis, CG was validated against measured GFR (mGFR) in 14 804 participants and compared with the Modification-of-Diet-in-Renal-Diseases (MDRD), Chronic-Kidney-Disease-Epidemiology (CKD-EPI), Lund-Malmö-Revised (LMR) and European-Kidney-Function-Consortium (EKFC) equations. Validation focused on bias, imprecision and accuracy (percentage of estimates within ±30% of mGFR, P30), overall and stratified for mGFR, age and body mass index at mGFR <60 mL/min, as well as classification in mGFR stages. Results:... (More)

Aim: The Cockcroft-Gault (CG) creatinine-based equation is still used to estimate glomerular filtration rate (eGFR) for drug dosage adjustment. Incorrect eGFR may lead to hazardous over- or underdosing. Methods: In a cross-sectional analysis, CG was validated against measured GFR (mGFR) in 14 804 participants and compared with the Modification-of-Diet-in-Renal-Diseases (MDRD), Chronic-Kidney-Disease-Epidemiology (CKD-EPI), Lund-Malmö-Revised (LMR) and European-Kidney-Function-Consortium (EKFC) equations. Validation focused on bias, imprecision and accuracy (percentage of estimates within ±30% of mGFR, P30), overall and stratified for mGFR, age and body mass index at mGFR <60 mL/min, as well as classification in mGFR stages. Results: The CG equation performed worse than the other equations, overall and in mGFR, age and BMI subgroups in terms of bias (systematic overestimation), imprecision and accuracy except for patients ≥65 years where bias and P30 were similar to MDRD and CKD-EPI, but worse than LMR and EKFC. In subjects with mGFR <60 mL/min and at BMI 18.5-25 kg/m2, all equations performed similarly, and for BMI < 18.5 kg/m2 CG and LMR had the best results though all equations had poor P30-accuracy. At BMI ≥ 25 kg/m2 the bias of the CG increased with increasing BMI (+17.2 mL/min at BMI ≥ 40 kg/m2). The four more recent equations also classified mGFR stages better than CG. Conclusions: The CG equation showed poor ability to estimate GFR overall and in analyses stratified for mGFR, age and BMI. CG was inferior to correctly classify the patients in the mGFR staging compared to more recent creatinine-based equations.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
chronic kidney disease, drug adjustment, glomerular filtration rate
in
British Journal of Clinical Pharmacology
volume
88
issue
5
pages
2118 - 2127
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:34709683
  • scopus:85120415018
ISSN
0306-5251
DOI
10.1111/bcp.15132
language
English
LU publication?
yes
id
c2a98b97-9be3-441c-9fbd-00722d5b35c6
date added to LUP
2022-01-17 13:52:32
date last changed
2022-08-12 02:47:06
@article{c2a98b97-9be3-441c-9fbd-00722d5b35c6,
  abstract     = {{<p>Aim: The Cockcroft-Gault (CG) creatinine-based equation is still used to estimate glomerular filtration rate (eGFR) for drug dosage adjustment. Incorrect eGFR may lead to hazardous over- or underdosing. Methods: In a cross-sectional analysis, CG was validated against measured GFR (mGFR) in 14 804 participants and compared with the Modification-of-Diet-in-Renal-Diseases (MDRD), Chronic-Kidney-Disease-Epidemiology (CKD-EPI), Lund-Malmö-Revised (LMR) and European-Kidney-Function-Consortium (EKFC) equations. Validation focused on bias, imprecision and accuracy (percentage of estimates within ±30% of mGFR, P30), overall and stratified for mGFR, age and body mass index at mGFR &lt;60 mL/min, as well as classification in mGFR stages. Results: The CG equation performed worse than the other equations, overall and in mGFR, age and BMI subgroups in terms of bias (systematic overestimation), imprecision and accuracy except for patients ≥65 years where bias and P30 were similar to MDRD and CKD-EPI, but worse than LMR and EKFC. In subjects with mGFR &lt;60 mL/min and at BMI 18.5-25 kg/m<sup>2</sup>, all equations performed similarly, and for BMI &lt; 18.5 kg/m<sup>2</sup> CG and LMR had the best results though all equations had poor P30-accuracy. At BMI ≥ 25 kg/m<sup>2</sup> the bias of the CG increased with increasing BMI (+17.2 mL/min at BMI ≥ 40 kg/m<sup>2</sup>). The four more recent equations also classified mGFR stages better than CG. Conclusions: The CG equation showed poor ability to estimate GFR overall and in analyses stratified for mGFR, age and BMI. CG was inferior to correctly classify the patients in the mGFR staging compared to more recent creatinine-based equations.</p>}},
  author       = {{Delanaye, Pierre and Björk, Jonas and Courbebaisse, Marie and Couzi, Lionel and Ebert, Natalie and Eriksen, Björn O. and Dalton, R. Neil and Dubourg, Laurence and Gaillard, Francois and Garrouste, Cyril and Grubb, Anders and Jacquemont, Lola and Hansson, Magnus and Kamar, Nassim and Lamb, Edmund J. and Legendre, Christophe and Littmann, Karin and Mariat, Christophe and Melsom, Toralf and Rostaing, Lionel and Rule, Andrew D. and Schaeffner, Elke and Sundin, Per Ola and Berg, Ulla B. and Åsling-Monemi, Kajsa and Selistre, Luciano and Åkesson, Anna and Larsson, Anders and Bökenkamp, Arend and Pottel, Hans and Nyman, Ulf}},
  issn         = {{0306-5251}},
  keywords     = {{chronic kidney disease; drug adjustment; glomerular filtration rate}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{2118--2127}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{British Journal of Clinical Pharmacology}},
  title        = {{Performance of creatinine-based equations to estimate glomerular filtration rate with a methodology adapted to the context of drug dosage adjustment}},
  url          = {{http://dx.doi.org/10.1111/bcp.15132}},
  doi          = {{10.1111/bcp.15132}},
  volume       = {{88}},
  year         = {{2022}},
}