比较用于指导肾移植受者用药的 eGFR 公式。

IF 5.3 2区 医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2024-11-01 Epub Date: 2024-10-22 DOI:10.1097/TP.0000000000005098
Ayub Akbari, Hajar El Wadia, Greg A Knoll, Christine A White, Manish M Sood, David Massicotte-Azarniouch, Christopher McCudden, Marie-Josee Deschenes, Maria Salman, Tim Ramsay, Gregory L Hundemer
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引用次数: 0

摘要

背景:护理肾移植受者(KTR)的临床医生最常使用估计肾小球滤过率(eGFR)来指导用药,因为它是最容易获得的肾功能测量指标。哪种 eGFR 方程能为 KTR 提供最准确的药物剂量指导仍不确定:我们对加拿大和新西兰的 415 名稳定 KTR 进行了研究。方法:我们对加拿大和新西兰的 415 名稳定 KTR 进行了研究,参与者完成了肌酐和胱抑素 C 的当日测量,并测量了 GFR(二乙烯三胺五乙酸)。慢性肾脏病流行病学协作组、欧洲肾功能联盟和移植专用的 eGFR 方程与 Cockcroft-Gault 肌酐清除率 (CrCl) 和测量的 GFR 进行了比较。eGFR 方程的评估既包括以 1.73 平方米标准化体表面积 (BSA) 为指标的评估(每 1.73 平方米每分钟毫升,这是大多数临床实验室的传统报告方法),也包括不以实际 BSA 为指标的评估(每分钟毫升)。主要结果是 8 种常用处方药相对于 Cockcroft-Gault CrCl 或测量的 GFR 的用药剂量不一致比例。根据肥胖状况进行了分层分析:结果:与指数化 eGFR 方程(每分钟毫升数)相比,非指数化 eGFR 方程(每分钟毫升数/1.73 m2)导致的药物剂量不一致率大大降低。这些发现在肥胖的 KTR 中最为明显,因为他们经常用药不足。与 Cockcroft-Gault CrCl 相比,非指数化 2023 移植专用方程的不一致比例最低。与测量的 GFR 相比,非指数化的 2021 年慢性肾脏病流行病学协作组织 Cr/CysC 公式的不一致比例最低:结论:临床医生应在 KTR 的用药剂量中使用考虑实际 BSA 的非指数 eGFR 值。这些发现可能会让 KT 提供者了解哪种 eGFR 方程能为 KTR 提供最安全、最准确的用药指导。
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Comparison of eGFR Equations to Guide Dosing of Medications for Kidney Transplant Recipients.

Background: Clinicians caring for kidney transplant recipients (KTRs) most commonly use estimated glomerular filtration rate (eGFR) to guide medication dosing as it is the most readily available measure of kidney function. Which eGFR equations provide the most accurate medication dosing guidance for KTRs remains uncertain.

Methods: We studied 415 stable KTRs in Canada and New Zealand. Participants completed same-day measurements of creatinine and cystatin C and measured GFR (diethylenetriaminepentaacetic acid). Chronic Kidney Disease Epidemiology Collaboration, European Kidney Function Consortium, and transplant-specific eGFR equations were compared with both Cockcroft-Gault creatinine clearance (CrCl) and measured GFR. eGFR equations were assessed both indexed to a standardized body surface area (BSA) of 1.73 m 2 (milliliter per minute per 1.73 m 2 , as is conventional reporting from most clinical laboratories) and nonindexed (milliliter per minute) accounting for actual BSA. The primary outcome was the proportion of medication dosing discordance relative to Cockcroft-Gault CrCl or measured GFR for 8 commonly prescribed medications. Stratified analyses were performed on the basis of obesity status.

Results: Nonindexed eGFR equations (milliliter per minute) resulted in substantially lower medication dosing discordance compared with indexed eGFR equations (milliliter per minute per 1.73 m 2 ). These findings were most pronounced among KTRs with obesity, in whom underdosing was frequent. When compared with Cockcroft-Gault CrCl, the lowest proportion of discordance was found with the nonindexed 2023 transplant-specific equation. When compared with measured GFR, the lowest proportion of discordance was found with the nonindexed 2021 Chronic Kidney Disease Epidemiology Collaboration Cr/CysC equation.

Conclusions: Nonindexed eGFR values accounting for actual BSA should be used by clinicians for medication dosing in KTRs. These findings may inform KT providers about which eGFR equations provide the safest, most accurate medication dosing guidance for KTRs.

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来源期刊
Transplantation
Transplantation 医学-免疫学
CiteScore
8.50
自引率
11.30%
发文量
1906
审稿时长
1 months
期刊介绍: The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation. ​
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