TY - JOUR
T1 - Kidney function estimates using cystatin C versus creatinine
T2 - Impact on medication prescribing in acutely hospitalized elderly patients
AU - Iversen, E
AU - Bodilsen, A C
AU - Klausen, H
AU - Treldal, C
AU - Andersen, O
AU - Houlind, M
AU - Petersen, J
N1 - © 2018 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).
PY - 2019/4
Y1 - 2019/4
N2 - Background: Medication errors due to inaccurate measures of kidney function are common among elderly patients. We investigated differences between estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C and how these differences would affect prescribing recommendations among acutely hospitalized elderly patients. We also identified factors associated with discrepancies between estimates. Methods: Estimated glomerular filtration rate and chronic kidney disease (CKD) classifications were determined for 338 acutely hospitalized elderly patients using equations from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Berlin Initiative Study (BIS) and Cockcroft-Gault (CG). Prescribed renal risk medications were compared with dosing guidelines in Renbase
® . Linear regression models were used to identify explanatory variables for eGFR discrepancies between equations. Muscle weakness was assessed by handgrip strength; inflammation was assessed by smoking status, serum C-reactive protein (CRP), soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-associated lipocalin (NGAL); and organ dysfunction was assessed by thyroid-stimulating hormone (TSH) and FI-OutRef. Results: Median eGFR values were 65.5, 60.7, 54.1, 57.1, 55.1 and 57.6 mL/min/1.73m
2 according to CKD-EPI
Cr , CKD-EPI
Comb , CKD-EPI
Cys , BIS
Cr , BIS
Comb and CG
Cr , respectively. Depending on choice of equation, renal risk medications were prescribed at higher than recommended dose in 13.6% to 22.5% of patients using normalized GFR units and 9.9% to 19.1% of patients using absolute units. Age, handgrip strength, CRP, suPAR, NGAL and smoking status had significant association with eGFR discrepancies between creatinine- and cystatin C-based equations. Conclusions: Significant discrepancies in eGFR and CKD classification were observed when switching between eGFR equations in acutely hospitalized elderly patients. Switching from a creatinine-based equation to its corresponding cystatin C-based equation resulted in lower GFR estimates, and these differences were larger than in community-dwelling older populations. Switching between CKD-EPI
Cr , CG
Cr and the alternative equations would result in clinically relevant changes to medication prescribing. Discrepancies between equations were associated with high age, muscle weakness and inflammation.
AB - Background: Medication errors due to inaccurate measures of kidney function are common among elderly patients. We investigated differences between estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C and how these differences would affect prescribing recommendations among acutely hospitalized elderly patients. We also identified factors associated with discrepancies between estimates. Methods: Estimated glomerular filtration rate and chronic kidney disease (CKD) classifications were determined for 338 acutely hospitalized elderly patients using equations from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Berlin Initiative Study (BIS) and Cockcroft-Gault (CG). Prescribed renal risk medications were compared with dosing guidelines in Renbase
® . Linear regression models were used to identify explanatory variables for eGFR discrepancies between equations. Muscle weakness was assessed by handgrip strength; inflammation was assessed by smoking status, serum C-reactive protein (CRP), soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-associated lipocalin (NGAL); and organ dysfunction was assessed by thyroid-stimulating hormone (TSH) and FI-OutRef. Results: Median eGFR values were 65.5, 60.7, 54.1, 57.1, 55.1 and 57.6 mL/min/1.73m
2 according to CKD-EPI
Cr , CKD-EPI
Comb , CKD-EPI
Cys , BIS
Cr , BIS
Comb and CG
Cr , respectively. Depending on choice of equation, renal risk medications were prescribed at higher than recommended dose in 13.6% to 22.5% of patients using normalized GFR units and 9.9% to 19.1% of patients using absolute units. Age, handgrip strength, CRP, suPAR, NGAL and smoking status had significant association with eGFR discrepancies between creatinine- and cystatin C-based equations. Conclusions: Significant discrepancies in eGFR and CKD classification were observed when switching between eGFR equations in acutely hospitalized elderly patients. Switching from a creatinine-based equation to its corresponding cystatin C-based equation resulted in lower GFR estimates, and these differences were larger than in community-dwelling older populations. Switching between CKD-EPI
Cr , CG
Cr and the alternative equations would result in clinically relevant changes to medication prescribing. Discrepancies between equations were associated with high age, muscle weakness and inflammation.
KW - Chronic kidney disease
KW - creatinine
KW - cystatin C
KW - elderly
KW - emergency department
UR - http://www.scopus.com/inward/record.url?scp=85058145381&partnerID=8YFLogxK
U2 - 10.1111/bcpt.13156
DO - 10.1111/bcpt.13156
M3 - Journal article
C2 - 30372593
SN - 1742-7843
VL - 124
SP - 466
EP - 478
JO - Basic & clinical pharmacology & toxicology
JF - Basic & clinical pharmacology & toxicology
IS - 4
ER -