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Clearance Confusion: An Exploratory Analysis of Inpatient Dosing Discordances Between Renal Estimating Equations
Annals of Pharmacotherapy ( IF 2.9 ) Pub Date : 2020-05-15 , DOI: 10.1177/1060028020922492
Sean M McConachie 1, 2 , Laila Shammout 2 , Dmitriy M Martirosov 2
Affiliation  

Background: Numerous equations exist for estimating renal clearance for drug dosing, and discordance rates may be as high as 40% in certain populations. However, the populations and types of equations used in these studies may not be generalizable to broader pharmacy practice. Objectives: To determine the dosing discordance rate between Cockcroft-Gault (C-G), Chronic Kidney Disease Epidemiology (CKD-EPI), and Modification of Diet in Renal Disease (MDRD) equations in a community hospital population. Methods: This was a cross-sectional analysis of inpatients who had documented renal function assessment over a 6-month period. Renal estimation was calculated using 5 equations (MDRD, CKD-EPI, and 3 C-G variants). Differences between equations were assessed using mean bias, dosing discordance, and agreement (κ statistic). Patients with acute kidney injury and those requiring renal replacement therapy were excluded. Results: A total of 466 patients were eligible for inclusion. Dosing discordance was evident between C-G variants and both MDRD and CKD-EPI equations in greater than 20% of patients. Agreement was highest between MDRD and CKD-EPI (κ = 0.93) and lowest between MDRD and C-G calculated using ideal body weight (κ = 0.33). The majority of discordant instances led to higher dosing recommendations when using MDRD and CKD-EPI equations compared with C-G variants. Dosing discordance exceeded 18% between the different C-G variants, with the highest discordance (36%) observed between total body weight and ideal body weight variants. Conclusion and Relevance: Dosing discordance between renal estimating equations is widespread. Practitioners and institutions should be aware of these differences when dosing medications and implementing renal dosing policies.

中文翻译:

清除混淆:肾估计方程之间住院剂量不一致的探索性分析

背景:存在许多用于估计药物剂量的肾脏清除率的方程,并且在某些人群中不一致率可能高达 40%。然而,这些研究中使用的人群和方程类型可能无法推广到更广泛的药学实践。目的:确定社区医院人群中 Cockcroft-Gault (CG)、慢性肾病流行病学 (CKD-EPI) 和肾病饮食修正 (MDRD) 方程之间的给药不一致率。方法:这是对 6 个月内有肾功能评估记录的住院患者的横断面分析。使用 5 个方程(MDRD、CKD-EPI 和 3 个 CG 变体)计算肾脏估计值。使用平均偏差、剂量不一致和一致性(κ 统计量)评估方程之间的差异。急性肾损伤患者和需要肾脏替代治疗的患者被排除在外。结果:共有 466 名患者符合纳入条件。在超过 20% 的患者中,CG 变异与 MDRD 和 CKD-EPI 方程之间的剂量不一致是明显的。MDRD 和 CKD-EPI 之间的一致性最高 (κ = 0.93),而使用理想体重计算的 MDRD 和 CG 之间的一致性最低 (κ = 0.33)。与 CG 变体相比,当使用 MDRD 和 CKD-EPI 方程时,大多数不一致的情况导致更高的剂量建议。不同 CG 变体之间的剂量不一致超过 18%,在总体重和理想体重变体之间观察到的最高不一致 (36%)。结论和相关性:肾脏估计方程之间的剂量不一致很普遍。
更新日期:2020-05-15
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