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Kidney function estimates using cystatin C versus creatinine: Impact on medication prescribing in acutely hospitalized elderly patients

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@article{7497e5630f7f4ef1bcbc328285421992,
title = "Kidney function estimates using cystatin C versus creatinine: Impact on medication prescribing in acutely hospitalized elderly patients",
abstract = "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 {\circledR} . 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.",
keywords = "Chronic kidney disease, creatinine, cystatin C, elderly, emergency department",
author = "E Iversen and Bodilsen, {A C} and H Klausen and C Treldal and O Andersen and M Houlind and J Petersen",
note = "{\circledC} 2018 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).",
year = "2019",
month = "4",
doi = "10.1111/bcpt.13156",
language = "English",
volume = "124",
pages = "466--478",
journal = "Basic & Clinical Pharmacology & Toxicology Online",
issn = "1742-7843",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "4",

}

RIS

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

VL - 124

SP - 466

EP - 478

JO - Basic & Clinical Pharmacology & Toxicology Online

JF - Basic & Clinical Pharmacology & Toxicology Online

SN - 1742-7843

IS - 4

ER -

ID: 55534244