Use of the Cockcroft-Gault versus the MDRD Study Equation to Dose Medications: An Opinion of the Nephrology Practice and Research Network of the American College of Clinical Pharmacy
AuthorNyman, Heather A.
Dowling, Thomas C.
Hudson, Joanna Q.
St. Peter, Wendy L.
Joy, Melanie S.
Nolin, Thomas D.
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AbstractAccurate assessment of kidney function is an important component of determining appropriate medication dosing regimens. Nearly all manufacturer-recommended dose adjustments are based on creatinine clearance ranges derived from clinical pharmacokinetic studies performed during the drug development process. The Cockcroft-Gault (C-G) equation provides an estimate of creatinine clearance and is the equation most commonly used to determine drug doses in patients with impaired kidney function. Recently, the Modification of Diet in Renal Disease Study (MDRD) equation has also been proposed for this purpose. Published studies report that drug doses determined by the two equations do not agree in 10-40% of cases. However, interpretation and comparison of these studies is complicated by the variable creatinine methods used for calculating C-G and MDRD estimates, the patient populations studied, and a lack of outcomes data demonstrating the clinical significance of dosing discrepancies. Moreover, the impact of reporting standardized serum creatinine values on the accuracy of the C-G equation and corresponding drug dosing regimens have been questioned. Currently, no prospective pharmacokinetic studies have been conducted using the MDRD equation to generate dosing recommendations, and limited data are available to support its use in some patient populations representing demographic extremes. Collectively, these issues have resulted in considerable confusion among clinicians and have fueled a healthy debate on whether or not to use the MDRD equation to dose medications. Each of these issues is reviewed, and a proposed algorithm for using creatinine-based kidney function assessments in medication dosing is provided. Knowledge of the advantages, limitations, and clinical role of each equation will facilitate their safe and effective use in medication dosing.
CitationNyman, H. A., Dowling, T. C., Hudson, J. Q., St. Peter, W. L., Joy, M. S., & Nolin, T. D. (2011). Comparative evaluation of the Cockcroft-Gault Equation and the modification of diet in Renal Disease (MDRD) Study Equation for Drug Dosing: An opinion of the Nephrology Practice and Research Network of the American College of Clinical Pharmacy. Pharmacotherapy, 31(11), 1130-1144, DOI: 10.1592/phco.31.11.1130.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/1410
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