[Dosing adjustment and renal function: Which equation(s)?]. - Archive ouverte HAL Access content directly
Journal Articles Néphrologie & Thérapeutique Year : 2016

[Dosing adjustment and renal function: Which equation(s)?].

Adaptation posologique des médicaments et fonction rénale : quel(s) estimateur(s) faut-il choisir ?

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Abstract

While the CKD-EPI (for Chronic Kidney Disease Epidemiology) equation is now implemented worldwide, utilization of the Cockcroft formula is still advocated by some physicians for drug dosage adjustment. Justifications for this recommendation are that the Cockcroft formula was preferentially used to determine dose adjustments according to renal function during the development of many drugs, better predicts drugs-related adverse events and decreases the risk of drug overexposure in the elderly. In this opinion paper, we discuss the weaknesses of the rationale supporting the Cockcroft formula and endorse the French HAS (Haute Autorité de santé) recommendation regarding the preferential use of the CKD-EPI equation. When glomerular filtration rate (GFR) is estimated in order to adjust drug dosage, the CKD-EPI value should be re-expressed for the individual body surface area (BSA). Given the difficulty to accurately estimate GFR in the elderly and in individuals with extra-normal BSA, we recommend to prescribe in priority monitorable drugs in those populations or to determine their "true" GFR using a direct measurement method.

Dates and versions

hal-01908951 , version 1 (30-10-2018)

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Pierre Delanaye, Martin Flamant, Etienne Cavalier, Fabrice Guerber, Thomas Vallotton, et al.. [Dosing adjustment and renal function: Which equation(s)?].. Néphrologie & Thérapeutique, 2016, 12 (1), pp.18 - 31. ⟨10.1016/j.nephro.2015.07.472⟩. ⟨hal-01908951⟩
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