Clinical Pharmacokinetics

, Volume 56, Issue 2, pp 193–205 | Cite as

Discrepancies between the Cockcroft–Gault and Chronic Kidney Disease Epidemiology (CKD-EPI) Equations: Implications for Refining Drug Dosage Adjustment Strategies

  • Pierre DelanayeEmail author
  • Fabrice Guerber
  • André Scheen
  • Timothy Ellam
  • Antoine Bouquegneau
  • Dorra Guergour
  • Christophe Mariat
  • Hans Pottel
Original Research Article



The dosages of many medications require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft–Gault (CG) equation, should be recommended to estimate glomerular filtration rate.


We used a mathematical simulation to determine how patient characteristics influence discrepancies between equations and analyzed clinical data to demonstrate the frequency of such discrepancies in clinical practice. In the simulation, the modifiable variables were sex, age, serum creatinine, and weight. We considered estimated glomerular filtration rate results in mL/min, deindexed for body surface area, because absolute excretory function (rather than per 1.73 m2 body surface area) determines the rate of filtration of a drug at a given plasma concentration. An absolute and relative difference of maximum (±) 10 mL/min and 10 %, respectively, were considered concordant. Clinical data for patients aged over 60 years (n = 9091) were available from one hospital and 25 private laboratories.


In the simulation, differences between the two equations were found to be influenced by each variable but age and weight had the biggest effect. Clinical sample data demonstrated concordance between CKD-EPI and CG results in 4080 patients (45 %). The majority of discordant results reflected a CG result lower than the CKD-EPI equation. With aging, the CG result became progressively lower than the CKD-EPI result. When weight increased, the opposite occurred.


The choice of equation for excretory function adjustment of drug dosage will have different implications for patients of different ages and body habitus.


The optimum equation for drug dosage adjustment should be defined with consideration of individual patient characteristics.


Glomerular Filtration Rate Isotope Dilution Mass Spectrometry Estimate Glomerular Filtration Rate Excretory Function Measured Glomerular Filtration Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflict of interest

Pierre Delanaye, Fabrice Guerber, André Scheen, Timothy Ellam, Antoine Bouquegneau, Dorra Guergour, Christophe Mariat, and Hans Pottel declare that they have no conflict of interest that might be relevant to the contents of this manuscript.

Supplementary material

40262_2016_434_MOESM1_ESM.xlsx (122 kb)
Supplementary material 1 (XLSX 121 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Pierre Delanaye
    • 1
    Email author
  • Fabrice Guerber
    • 2
  • André Scheen
    • 3
  • Timothy Ellam
    • 4
  • Antoine Bouquegneau
    • 1
  • Dorra Guergour
    • 5
  • Christophe Mariat
    • 6
  • Hans Pottel
    • 7
  1. 1.Division of Nephrology, Dialysis and Transplantation, CHU Sart TilmanUniversity of Liège (ULg-CHU)LiègeBelgium
  2. 2.Oriade LaboratoryVizilleFrance
  3. 3.Division of Clinical Pharmacology, Center for Interdisciplinary Research on MedicinesUniversity of LiègeLiègeBelgium
  4. 4.Sheffield Kidney Institute, Northern General Hospital and Department of Infection, Immunity and Cardiovascular ScienceUniversity of SheffieldSheffieldUK
  5. 5.Biochemistry LaboratoryGrenoble University HospitalGrenobleFrance
  6. 6.Division of Nephrology, Dialysis, Transplantation and Hypertension, CHU Hôpital NordUniversity Jean Monnet, PRES Université de LYONSaint-EtienneFrance
  7. 7.Department of Public Health and Primary CareKU, Leuven KulakKortrijkBelgium

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