Impact of using different renal function estimation equations on vancomycin dosing.

IF 1.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Laura Gratacós, Dolors Soy-Muner
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引用次数: 0

Abstract

Objectives: To assess which of the formulae for estimating renal function (Cockcroft-Gault (CG), Chronic Kidney Disease Epidemiology Collaboration CKD-EPI) and Modification of Diet in Renal Disease (MDRD)) provides the most accurate prediction of minimum vancomycin concentration (Cmin) and to evaluate whether they can be interchanged to optimise vancomycin dosage.

Methods: An observational and retrospective study was undertaken in hospitalised adult patients treated with intravenous vancomycin. Patients with serum creatinine (Scr) >2 mg/dL and <0.5 mg/dL, body mass index >40 kg/m2, need for extracorporeal clearance techniques and unstable renal function were excluded. Bayesian analysis was used to obtain individual pharmacokinetic parameters. Vancomycin clearance (CLvan) was calculated by means of CG (eCLvanCG), CKD-EPI (eCLvanCKD-EPI) and MDRD (eCLvanMDRD) and used to obtain Cmin estimates (eCmin). eCmin and observed Cmin were compared using an intraclass correlation coefficient (ICC). A post-hoc analysis by subgroups (age, sex, weight, Scr and estimated glomerular filtration rate (eGFR)) was performed. From each eCLvan, the area under the curve (AUC) was calculated and categorised as AUC <400 mg*hour/L, AUC 400-600 mg*hour/L and AUC >600 mg*hour/L. The kappa coefficient was applied to study AUC concordance.

Results: A total of 228 patients (69.3% men) were included. eCminCG had a statistically significant better agreement with Cmin (ICC >0.7) and showed good agreement in almost all subgroups. Patients with Scr >1.1 mg/dL were the only subgroup in which eCminMDRD and eCminCKD-EPI had an adequate ICC with no statistically significant differences compared with eCminCG. eCminMDRD had a similar ICC to eCminCG in the eGFR <60 mL/min and age 46-75 years subgroups. Kappa values showed regular agreement in all subgroups: 0.32 (AUC <400 mg*hour/L), 0.24 (AUC 400-600 mg*hour/L) and 0.41 (AUC >600 mg*hour/L).

Conclusions: The CG formula provides the most accurate prediction of vancomycin Cmin. In patients with eGFR <60 mL/min and aged 46-75 years, MDRD also shows a good predictive capacity. However, in low weight and elderly patients, Cmin predictions are superior with CG. Therefore, renal function estimation equations should not be considered interchangeable for vancomycin dose adjustments.

使用不同肾功能估计方程对万古霉素剂量的影响。
目的:评估哪一种评估肾功能的公式(Cockcroft-Gault (CG)、慢性肾脏疾病流行病学合作组织CKD-EPI)和肾脏疾病饮食调整(MDRD))能最准确地预测万古霉素最低浓度(Cmin),并评估它们是否可以互换以优化万古霉素剂量。方法:对静脉注射万古霉素的住院成年患者进行观察性和回顾性研究。排除血清肌酐(Scr)低于2 mg/dL和40 kg/m2、需要体外清除技术和肾功能不稳定的患者。贝叶斯分析获得个体药代动力学参数。通过CG (eCLvanCG)、CKD-EPI (eclvanck - epi)和MDRD (eCLvanMDRD)计算万古霉素清除率(CLvan),并用于估算Cmin (eCmin)。用类内相关系数(ICC)比较eCmin和观察到的Cmin。按亚组(年龄、性别、体重、Scr和估计肾小球滤过率(eGFR))进行事后分析。从每个eCLvan中计算曲线下面积(AUC),并将AUC分类为600 mg*hour/L。采用kappa系数研究AUC一致性。结果:共纳入228例患者,其中男性69.3%。eCminCG与Cmin (ICC >.7)具有统计学意义上更好的一致性,并且在几乎所有亚组中都表现出良好的一致性。Scr为1.1 mg/dL的患者是eCminMDRD和eCminCKD-EPI中唯一具有足够ICC的亚组,与eCminCG相比无统计学差异。eCminMDRD与eCminCG在eGFR (600 mg*小时/L)中具有相似的ICC。结论:使用CG公式预测万古霉素Cmin最准确。在eGFR患者中
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来源期刊
CiteScore
3.40
自引率
5.90%
发文量
104
审稿时长
6-12 weeks
期刊介绍: European Journal of Hospital Pharmacy (EJHP) offers a high quality, peer-reviewed platform for the publication of practical and innovative research which aims to strengthen the profile and professional status of hospital pharmacists. EJHP is committed to being the leading journal on all aspects of hospital pharmacy, thereby advancing the science, practice and profession of hospital pharmacy. The journal aims to become a major source for education and inspiration to improve practice and the standard of patient care in hospitals and related institutions worldwide. EJHP is the only official journal of the European Association of Hospital Pharmacists.
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