Advertisement

International Journal of Clinical Pharmacy

, Volume 37, Issue 5, pp 675–677 | Cite as

Renal function overestimation in underweight and/or non-ambulatory patients

  • Fazlollah KeshavarziEmail author
Commentary
  • 261 Downloads

Abstract

Creatinine clearance estimation is widely used to evaluate the renal function of the patients in order to initiate or adjust the drugs dosage. However serum creatinine, as a muscle metabolism by-product, may not be a reliable parameter in underweight and/or non-ambulatory patients, such as geriatric, acquired immunodeficiency syndrome patients and bed-confined and cachexic cases. To avoid overestimation of the renal function in those patients, serum cystatin C can be considered as a sensitive and accurate alternative for serum creatinine.

Keywords

Bed-confined Creatinine clearance Cystatin C Renal function overestimation Underweight patients 

Notes

Funding

None.

Conflicts of interest

No any competing interest is declared.

References

  1. 1.
    Guidance for industry: pharmacokinetics in patients with impaired renal function—study design, data analysis, and impact on dosing and labeling. Food and Drug Administration. http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm204959.pdf.
  2. 2.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Salazar DE, Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988;84:1053–60.CrossRefPubMedGoogle Scholar
  5. 5.
    Drusano GL, Muncie HL, Hoopes JM, Damron DJ, Warren JW. Commonly used methods of estimating creatinine clearance are inadequate for elderly debilitated nursing home patients. J Am Geriatr Soc. 1988;36:437–41.CrossRefPubMedGoogle Scholar
  6. 6.
    Reichley RM, Ritchie DJ, Bailey TC. Analysis of various creatinine clearance formulas in predicting gentamicin elimination in patients with low serum creatinine. Pharmacotherapy. 1995;15(5):625–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft-Gault equation. Pharmacotherapy. 2012;32(7):604–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, Rossert J, Van Lente FV, Bruce RD, Zhang Y, Greene T, Levey AS. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis. 2008;51(3):395–406.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Zhang M, Cao X, Cai G, Wu D, Wei R, Yuan X, et al. Clinical evaluation of serum cystatin C and creatinine in patients with chronic kidney disease: a meta-analysis. J Int Med Res. 2013;41(4):944–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Dossetor JB. Creatininemia versus uremia. The relative significance of blood urea nitrogen and serum creatinine concentrations in azotemia. Ann Intern Med. 1966;65(6):1287–99.CrossRefPubMedGoogle Scholar
  11. 11.
    WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.CrossRefGoogle Scholar
  12. 12.
    Smythe M, Hoffman J, Kizy K, Drnuchowski C. Estimating creatinine clearance in elderly patients with low serum creatinine concentrations. Am J Hosp Pharm. 1994;51:198–204.PubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  1. 1.UCSI UniversityKuala LumpurMalaysia

Personalised recommendations