The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury.
<h4>Background</h4>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 s...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0225601 |
| _version_ | 1819025914959233024 |
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| author | Yuenting D Kwong Sheldon Chen Rima Bouajram Fanny Li Michael A Matthay Kala M Mehta David V Glidden Kathleen D Liu |
| author_facet | Yuenting D Kwong Sheldon Chen Rima Bouajram Fanny Li Michael A Matthay Kala M Mehta David V Glidden Kathleen D Liu |
| author_sort | Yuenting D Kwong |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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. |
| first_indexed | 2024-12-21T05:18:15Z |
| format | Article |
| id | doaj.art-55a8c1ebd8d54d578ed0a8fdc33acd3f |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T05:18:15Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-55a8c1ebd8d54d578ed0a8fdc33acd3f2022-12-21T19:14:52ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-011411e022560110.1371/journal.pone.0225601The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury.Yuenting D KwongSheldon ChenRima BouajramFanny LiMichael A MatthayKala M MehtaDavid V GliddenKathleen D Liu<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.https://doi.org/10.1371/journal.pone.0225601 |
| spellingShingle | Yuenting D Kwong Sheldon Chen Rima Bouajram Fanny Li Michael A Matthay Kala M Mehta David V Glidden Kathleen D Liu The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury. PLoS ONE |
| title | The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury. |
| title_full | The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury. |
| title_fullStr | The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury. |
| title_full_unstemmed | The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury. |
| title_short | The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury. |
| title_sort | value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury |
| url | https://doi.org/10.1371/journal.pone.0225601 |
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