Renal: Dosing

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Renal: Dosing
2013-04-14 20:09:42
renal dosing

Review evaluation of renal function in dosing medications in patients with renal disease.
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  1. SCr
    Creatine prod. in liver -> stored in muscle as creatine phosphate -> released as creatinine and elim. @ kidney

    90% filtered, 10% secreted

    Not used as sole marker for evaluating renal function

    Standardization of values 2010 (IDMS)
  2. Cystatin C
    Low weight protein prod. by all nucleated cells

    Freely filters -> reabsorbed & catabolized by tubular epithelials

    Role clinically undefined (does confirm CKD)

    Expensive & Non-standardized
  3. Cockroft-Gault CrCl
    [(140-Age) x kg]/(SCrx72) x 0.85 if female

    Stable renal fxn only

    Overestimates renal fxn

    Never adjusted for IDMS standardization

    Problematic w/elderly @ <1.0 SCr

    Obese weight adj. contraversial
  4. IBW
    • Male: 50 + 2.3(Inches - 60)
    • Female: 45.5 + 2.3(Inches - 60)
  5. AjBW
    0.4(Actual BW - IBW) + IBW

    Use if actual weight is >/= 130% IBW
  6. MDRD
    Report any value >59 as ">59"

    Stable renal fxn only

    Underestimates GFR

    Must adjust for BSA if used for dosing

    Nottested in elderly (>85yo)
  7. MDRD Pearls
    Pop. screening tool

    Reported w/ most lab data

    MDs use w/o adjusting for BSA to dose
  8. CKD-EPI Creatinine
    Most accurate

    Stable renal fxn only

    Not valid in kids, pregnancy, & some ethnicities

    Not adapted to clinical practice

    Not valid for dosing

    Not accurate @ > 60

    Cr-Cystatin more accurate than either alone
  9. Salazar-Corcoran
    use kg & meters

    Stable renal fxn only

    Morbidly obese pts only

    Not common in practice

    Uses fat-free body mass