The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury


Autoři: Yuenting D. Kwong aff001;  Sheldon Chen aff002;  Rima Bouajram aff003;  Fanny Li aff003;  Michael A. Matthay aff004;  Kala M. Mehta aff005;  David V. Glidden aff005;  Kathleen D. Liu aff001
Působiště autorů: Department of Medicine, Division of Nephrology, University of California at San Francisco School of Medicine, San Francisco, CA, United States of America aff001;  Department of Medicine, Division of Nephrology, MD Anderson, Houston, TX, United States of America aff002;  Department of Pharmaceutical Services, University of California at San Francisco Medical Center, San Francisco, CA, United States of America aff003;  Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States of America aff004;  Department of Epidemiology and Biostatistics, University of California at San Francisco School of Medicine, San Francisco, CA, United States of America aff005;  Department of Anesthesia, Division of Critical Care Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, United States of America aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225601

Souhrn

Background

In acute kidney injury (AKI), medication dosing based on Cockcroft-Gault creatinine clearance (CrCl) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rates (eGFR) are not valid when serum creatinine (SCr) is not in steady state. The aim of this study was to determine the impact of a kinetic estimating equation that incorporates fluctuations in SCrs on drug dosing in critically ill patients.

Methods

We used data from participants enrolled in the NIH Acute Respiratory Distress Syndrome Network Fluid and Catheters Treatment Trial to simulate drug dosing category changes with the application of the kinetic estimating equation developed by Chen. We evaluated whether kinetic estimation of renal function would change medication dosing categories (≥60, 30–59, 15–29, and <15mL/min) compared with the use of CrCl or CKD-EPI eGFR.

Results

The use of kinetic CrCl and CKD-EPI eGFR resulted in a large enough change in estimated renal function to require medication dosing recategorization in 19.3% [95 CI 16.8%–21.9%] and 23.4% [95% CI 20.7%–26.1%] of participants, respectively. As expected, recategorization occurred more frequently in those with AKI. When we examined individual days for those with AKI, dosing discordance was observed in 8.5% of total days using the CG CrCl and 10.2% of total days using the CKD-EPI equation compared with the kinetic counterparts.

Conclusion

In a critically ill population, use of kinetic estimates of renal function impacted medication dosing in a substantial proportion of AKI participants. Use of kinetic estimates in clinical practice should lower the incidence of medication toxicity as well as avoid subtherapeutic dosing during renal recovery.

Klíčová slova:

Acute respiratory distress syndrome – Catheters – Creatinine – Glomerular filtration rate – Kidneys – Nephrology – Renal system – Toxicity


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 11