从 Cockcroft-Gault 肌酐清除率转向无种族限制的估计肾小球滤过率,以改善不同医疗机构成人的用药决策:全美肾脏基金会工作小组就实施基于无种族限制的 eGFR 的用药决策达成共识。

IF 2.3 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Wendy L St Peter, Andrew S Bzowyckyj, Tracy Anderson-Haag, Linda Awdishu, Michael Blackman, Andrew Bland, Ethan Chan, Christine Chmielewski, Cynthia Delgado, Rachel Eyler, Charles Foster, Joanna Hudson, Sandra L Kane-Gill, Mary Ann Kliethermes, Tuan Le, Rajanikanth Madabushi, Brianna Martin, W Greg Miller, Joshua J Neumiller, Ann M Philbrick, Glenda Roberts, Venita Schandorf, Andrew J Webb, Dennis Wu, Thomas D Nolin
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引用次数: 0

摘要

目的:本文的目标是(1)提供证据和专家共识,以支持在医疗和用药相关决策中,使用无种族差异的估计肾小球滤过率(eGFR)代替 Cockcroft-Gault 估计肌酐清除率(C-G eCrCL),来估算肾功能稳定的成年人的肾脏滤过情况,以及(2)展示当个人体表面积(BSA)高于或低于 1.73 m2 时,如何根据体表面积调整 eGFR 结果,以改善用药相关决策的结果。摘要:尽管存在更精确的 eGFR 方程,但美国药剂师仍主要使用 C-G eCrCL 来确定 eGFR,以便做出与用药相关的决定。有几个驱动因素使临床实践从使用 C-G eCrCL 转向使用 eGFR 成为理想时机。这些因素包括(1) 2024 年美国食品和药物管理局 (FDA) 行业指南建议使用 eGFR 而不是 C-G eCrCL 来评估对肾功能受损患者药代动力学的影响;(2) 美国国家肾脏基金会 (NKF) 和美国肾脏病学会联合工作组建议在医疗和药物相关决策中使用 3 种无种族差异的慢性肾脏病流行病学协作组织 (CKD-EPI) eGFR 方程;(3) 美国临床实验室几乎普遍使用标准化血清肌酐测定方法;以及 (4) 越来越多的血清胱抑素 C 可用于 eGFR 评估。本出版物将指导从业人员了解在与用药相关的决策中使用无种族 eGFR 方程的基本原理,以及如何实施这一实践变革:NKF 基于无种族 eGFR 的用药相关决策实施工作组建议,医疗系统、医疗机构、临床实验室、电子健康记录系统、药典和数据供应商以及参与用药相关决策的医疗从业人员应从 C-G eCrCL 向无种族 eGFR 方程过渡,以便更准确地评估肾脏滤过情况,并在全美范围内实现用药和医疗决策的一致性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions.

Purpose: The goals of this paper are to (1) provide evidence and expert consensus to support a unified approach to estimating kidney filtration in adults with stable kidney function using race-free estimated glomerular filtration rate (eGFR) in place of Cockcroft-Gault estimated creatinine clearance (C-G eCrCL) for medical and medication-related decisions, and (2) demonstrate how adjusting eGFR results for an individual's body surface area (BSA) when it is higher or lower than 1.73 m2 will improve results for medication-related decisions.

Summary: C-G eCrCL is predominantly used by US pharmacists to determine eGFR for the purposes of medication-related decisions, even though more accurate eGFR equations exist. Several driving factors make it the ideal time to shift clinical practice from using C-G eCrCL to eGFR. These factors include the following: (1) 2024 Food and Drug Administration (FDA) guidance for industry recommends eGFR over C-G eCrCL to evaluate the impact on pharmacokinetics in patients with impaired kidney function; (2) a joint National Kidney Foundation (NKF) and American Society of Nephrology task force recommends 3 race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR equations for medical and medication-related decision-making; (3) the almost ubiquitous use of standardized serum creatinine assay methods in US clinical laboratories; and (4) increasing availability and use of serum cystatin C for eGFR assessment. This publication guides practitioners through the rationale for using race-free eGFR equations for medication-related decisions and how to implement this practice change.

Conclusion: The NKF Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions suggests that health systems, health settings, clinical laboratories, electronic health record systems, compendia and data vendors, and healthcare practitioners involved with medication-related decision-making transition away from C-G eCrCL and towards the race-free eGFR equations for more accurate assessment of kidney filtration and consistency in medication and medical decision-making across the US.

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来源期刊
CiteScore
2.90
自引率
18.50%
发文量
341
审稿时长
3-8 weeks
期刊介绍: The American Journal of Health-System Pharmacy (AJHP) is the official publication of the American Society of Health-System Pharmacists (ASHP). It publishes peer-reviewed scientific papers on contemporary drug therapy and pharmacy practice innovations in hospitals and health systems. With a circulation of more than 43,000, AJHP is the most widely recognized and respected clinical pharmacy journal in the world.
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