Establishing discordance rate of estimated glomerular filtration rate between serum creatinine-based calculations and cystatin-C-based calculations in critically ill patients.

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Pharmacotherapy Pub Date : 2025-03-01 Epub Date: 2025-02-13 DOI:10.1002/phar.70000
Victoria L Williams, Anthony T Gerlach
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引用次数: 0

Abstract

Introduction: The use of serum creatinine (SCr) for drug dosing has significant limitations and is influenced by many non-kidney factors. Cystatin C (cysC) is an alternative or additional marker of kidney function that is less affected by non-kidney factors. Although cysC may be useful in hospitalized patients, the use of cysC to calculate drug dosing in critically ill patients has been incompletely investigated.

Objective: The objective of this study was to determine the rate of discordance in estimated glomerular filtration rate (eGFR) between SCr-based calculations and SCr/cysC-based calculations that affect drug dosing in critically ill patients.

Methods: This was a single-center, retrospective, observational cohort study at an academic medical center including critically ill adult patients admitted in 2023 with SCr and cysC ordered. Data were collected via chart review. Demographic data were analyzed via descriptive statistics. Discordance, defined as the percentage of times at which there is at least one discrepancy in kidney dosing for a medication using Cockcroft-Gault (CG) creatinine clearance versus Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR creatinine-cystatin C (eGFRcr-cys) equations, was analyzed via Wilcoxon matched pair signed ranked sum. eGFR calculations were normalized for patients' body surface area for comparison.

Results: The study population included 232 patients (53.02% female; mean age 58.7 +/- 14.9 years; with 62.5% in medical, 23.28% in surgical, and 8.62% in neurological intensive care) with a median SCr of 0.94 mg/dL IQR [0.57-1.58] and median cysC of 1.92 mg/L IQR [1.27-2.77]. The median clearance rates were 68.5 mL/min (45.3-111.5) for CG and 53.9 mL/min (30.9-80.7) for CKD-EPI eGFRcr-cys; p < 0.001. The discordance rate across all study drugs was 32.3% (75/232). The four most common study drugs demonstrating discordance were cefepime 40.6% (52/128), vancomycin 38.3% (46/120), levetiracetam 35.1% (13/37), and piperacillin/tazobactam 11.6% (5/43).

Conclusion: Clinically significant discordance exists between SCr and SCr/cysC-based estimates of kidney function. This study established a discordance rate, as defined by drug dosing, of 32.3% in adult patients admitted to the ICU.

危重患者血清肌酐计算与胱抑素c计算估算肾小球滤过率的不一致性。
使用血清肌酐(SCr)来给药有明显的局限性,并且受许多非肾脏因素的影响。胱抑素C (Cystatin C, cysC)是一种替代或附加的肾功能标志物,受非肾脏因素的影响较小。尽管cysC可能对住院患者有用,但对危重患者使用cysC计算药物剂量的研究还不完全。目的:本研究的目的是确定基于SCr计算的肾小球滤过率(eGFR)与基于SCr/ cysc计算的肾小球滤过率(eGFR)在影响危重患者药物剂量方面的不一致率。方法:这是一项在某学术医学中心进行的单中心、回顾性、观察性队列研究,纳入了2023年入院的SCr和cysC危重成人患者。通过图表审查收集数据。人口统计数据通过描述性统计进行分析。不一致性,定义为使用Cockcroft-Gault (CG)肌酐清除率与慢性肾脏疾病流行病学协作(CKD-EPI) eGFR肌酐-胱抑素C (eGFRcr-cys)方程的肾脏给药至少存在一次差异的时间百分比,通过Wilcoxon配对对签名排序和进行分析。将患者体表面积的eGFR计算归一化以进行比较。结果:纳入研究人群232例,其中女性53.02%;平均年龄58.7±14.9岁;其中内科62.5%,外科23.28%,神经内科重症监护8.62%),中位SCr为0.94 mg/L IQR[0.57-1.58],中位cysC为1.92 mg/L IQR[1.27-2.77]。CG的中位清除率为68.5 mL/min (45.3-111.5), CKD-EPI eGFRcr-cys为53.9 mL/min (30.9-80.7);结论:SCr和基于SCr/ cysc的肾功能评估之间存在显著的临床差异。该研究确定了ICU成年患者的不一致性率(以药物剂量定义)为32.3%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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