eGFR in changing drug regimens

doi:10.1136/bmj.39247.716806.3A

BMJ 2007;334:1287 (23 June), doi:10.1136/bmj.39247.716806.3A

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Glomerular filtration rate

eGFR in changing drug regimens

The first 150 words of the full text of this article appear below.

Giles and Fitzmaurice did not discuss another use of estimatedrenal function—to guide changes in the dosage regimensof drugs that are eliminated unchanged by the kidneys, thathave active metabolites that are eliminated by the kidneys,or whose pharmacodynamic effects are affected by renal insufficiency.¹This is particularly important for drugs that have a low therapeuticindex.

Recommendations about drug dosage regimens given in manufacturers'summaries of product characteristics and in secondary sources,such as the British National Formulary, are based on creatinineclearance. It is therefore customary when altering dosage regimensin renal insufficiency to estimate glomerular filtration rate(GFR) by using calculated creatinine clearance, usually derivedfrom the Cockcroft-Gault equation for adults² or the Schwartz-Haycockequation for children.³

The eGFR estimated by the modified four variable modificationof diet in renal disease (MDRD) equation underestimates trueGFR more than the Cockcroft-Gault equation does in younger patients. . . [Full text of this article]

Jeffrey K Aronson, reader in clinical pharmacology

Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HA

jeffrey.aronson@clinpharm.ox.ac.uk

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Formula estimation of glomerular filtration rate: have we gone wrong?: Paul D Giles and David A Fitzmaurice
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