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Ann Pharmacother. 2013 Jul-Aug;47(7-8):1039-44. doi: 10.1345/aph.1S176. Epub 2013 Jun 11.

Functional range of creatinine clearance for renal drug dosing: a practical solution to the controversy of which weight to use in the Cockcroft-Gault equation.

Author information

1
Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA. daniel_brown@pba.edu

Abstract

OBJECTIVE:

To describe a practical solution for addressing body weight when using the Cockcroft-Gault equation to determine drug dosing.

DATA SOURCES:

A literature search was conducted using PubMed MEDLINE (1980-April 2013) using creatinine clearance, Cockcroft and Gault, Cockcroft-Gault, body weight, and obesity as search terms. Reference citations from publications reviewed were included.

STUDY SELECTION AND DATA EXTRACTION:

All English-language articles identified by the search were reviewed. Studies comparing the accuracy and bias of the Cockcroft-Gault equation using a variety of body weight designations in adult populations were included in the analysis.

DATA SYNTHESIS:

Study results indicated that, for obese patients, ideal body weight (IBW) underestimates creatinine clearance (CrCl) and total body weight (TBW) overestimates CrCl. Some studies suggest that adjusted body weight with a factor of 0.4 is most accurate, while others suggest the use of lean body weight. These studies have failed to produce a definitive resolution to the controversy. Despite many well-designed studies, the Cockcroft-Gault body weight controversy remains unresolved and uncertainty continues to exist as to which form of weight should be used in the equation. A different perspective is warranted. Since renal dosing guidelines are generally based on ranges of CrCl, applying a CrCl range to describe a patient's renal function might be more practical than relying on a specific CrCl value. Ultimately, CrCl-based drug dosing involves the use of an imperfect mathematical approximation, which is then applied as precisely as possible to the benefit versus risk analysis for a specific patient.

CONCLUSIONS:

We propose the use of a CrCl range for drug dosing purposes, with the lower boundary defined by using IBW in the Cockcroft-Gault equation and the upper boundary by using TBW.

PMID:
23757387
DOI:
10.1345/aph.1S176
[Indexed for MEDLINE]

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