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Comparison of equations for dosing of medications in renal impairment


Khanal, A and Peterson, GM and Jose, MD and Castelino, RL, Comparison of equations for dosing of medications in renal impairment, Nephrology, 22, (6) pp. 470-477. ISSN 1320-5358 (2017) [Refereed Article]

Copyright Statement

Copyright 2016 Asian Pacific Society of Nephrology

DOI: doi:10.1111/nep.12834


Aim: The aim of this study is to determine the concordance among the Cockcroft-Gault, the Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in hypothetical dosing of renally cleared medications.

Methods: A total of 2163 patients prescribed at least one of the 31 renally cleared drugs under review were included in the study. Kidney function was estimated using the three equations. We compared actual prescribed dosages of the same drug with recommended dosages based on the kidney function as calculated by each of the equations and applying dosing recommendations in the Australian Medicines Handbook.

Results: There was a significant difference in the kidney function values estimated from the three equations (P < 0.001). Despite the good overall agreement in renal drug dosing, we found selected but potentially important discrepancies among the doses rendered from the equations. The CKD-EPI equation non-normalized for body surface area had a greater rate of concordance with the Cockcroft-Gault equation than the Modification of Diet in Renal Disease equation for renal drug dosing.

Conclusions: 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.

Item Details

Item Type:Refereed Article
Keywords:drug dosage, kidney disease, safety, CKD-EPI equation, Cockcroft-Gault equation, eGFR, kidney function, kidney function estimating equations, MDRD equation
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacology and Therapeutics
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Urogenital System and Disorders
UTAS Author:Khanal, A (Ms Aarati Khanal)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
UTAS Author:Jose, MD (Professor Matthew Jose)
UTAS Author:Castelino, RL (Dr Ronald Castelino)
ID Code:116420
Year Published:2017
Web of Science® Times Cited:4
Deposited By:Medicine
Deposited On:2017-05-09
Last Modified:2018-08-28

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