When a patient on the ICU is in a state of rapidly changing renal function all calculations for drug dosing will be difficult. However, I think it is inappropriate to wait for a 24 hr urine sampling to perform a proper creatinin clearance. Some way or another a best estimate will be needed to dose the necessary drugs.
I'm not a pharmacist, but I think only for the drugs with dosing recommendations that included narrow GFR ranges the current formulae are not yet sufficient. It is necessary that laboratorians explain the formulae to clinical doctors. The eGFR-MDRD has to be recalculated to the patients own body surface area as in its current form it is expressed to the (unexplainable small) body surface of 1,73 m^2. That can hardly be regarded as a 'normal' body surface area.
This is the reference to the article of Stevens et al:
Stevens et al. published a report in 2009 titled "Comparison of Drug Dosing Recommendations Based on Measured GFR and Kidney Function Estimating Equations", Am J Kidney Dis. 2009 July ; 54(1): 33-42.
Best regards
Dirk Bakkeren, PhD
Clinical chemist
Máxima Medisch Centrum
Postbus 7777
5500 MB Veldhoven
The Netherlands
-----Oorspronkelijk bericht-----
Van: Clinical biochemistry discussion list [mailto:[log in to unmask]] Namens Jonathan Kay
Verzonden: 21 maart 2011 13:14
Aan: [log in to unmask]
Onderwerp: eGFR
Specifically around use in secondary care:
Isn't it widely believed that eGFR isn't a valid estimate of GFR when renal function is rapidly changing? I don't think that plasma creatinine stops being a valid estimate of plasma creatinine in that situation.
For laboratories that report eGFR in secondary care for the specific function of improving drug dosing please could they say which formula they use. Isn't it better for this purpose to use one that includes the patient's mass?
Jonathan
On 18 Mar 2011, at 16:45, EDMUND LAMB wrote:
>
> Those concerned about reporting eGFR in inpatients because of rapidly changing cardiovascular or renal function, presumably don't report creatinine in such patients either?
>
> Edmund
>
>
------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
_____________________________________________________________________________________________
De informatie verzonden met dit e-mail bericht is uitsluitend bestemd voor de geadresseerde. Gebruik van deze informatie door anderen dan de geadresseerde is verboden. Openbaarmaking, vermenigvuldiging, verspreiding en/of verstrekking van deze informatie aan derden is niet toegestaan. Máxima Medisch Centrum staat niet in voor de juiste en volledige overbrenging van de inhoud van een verzonden e-mail, noch voor tijdige ontvangst daarvan.
_____________________________________________________________________________________________
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|