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Year : 2020  |  Volume : 10  |  Issue : 5  |  Page : 1-5

Discordance of renal drug dosing using estimated creatinine clearance and measured urine creatinine clearance in hospitalized adults: A retrospective cohort study

Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA

Correspondence Address:
Dr. Anthony T Gerlach
Room 368 Doan Hall, 410 West 10th Avenue, Columbus, Ohio 43210
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCIIS.IJCIIS_61_19

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Background: Assessment of kidney function is fundamental to optimize drug dosing. The Cockcroft–Gault (CG) equation is widely used but has questionable validity for females, changing renal function, and the critical ill. Eight-hour urine collections (U8h) offer direct measurement of creatinine clearance (CrCl) but lack the data for drug dosing. The primary objective of this study was to determine if there was a difference in renal drug dosing based on the estimation of CG CrCl (CrClCG) versus 8-h CrCl (CrCl8h). Methods: This was an observational, retrospective cohort study of adult patients admitted between March 2018 and September 2018 with a collection U8hduring hospitalization. The primary outcome was discordance of renal drug dosing defined as the percentage of U8hfor which at least one different active medication CrCl dosing cutoff would result using the CrClCGversus CrCl8h. The secondary outcomes were correlation between CrClCGand CrCl8hand percentage of CrClCGvalues outside ± 20% of the CrCl8h. Results: One hundred collections drawn from 85 unique patients (50.6% male, median age 55 [41–70] years, intensive care unit 88%) were included in the analysis. Median serum creatinine was 0.76 (0.52–1.06) mg/dL and blood urea nitrogen was 20 (14–28) mg/dL at time of collection8h. Median CrCl8hwas 86.2 (43.5–140.3) mL/min versus 99.7 (56.5–166.9) mL/min CrClCG(P < 0.001) and discordance was 25%. The correlation between CrCl8hand CrClCGwas 0.76 (P < 0.001). Only 31% of CrClCGvalues were within ± 20% of the CrCl8hvalue. Conclusion: We found 25% discordance for drug dosing between CrCl8hand CrClCG.Further studies are needed to determine the impact on clinical outcomes.

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