比较 Cockcroft-Gault、MDRD 和 CKD-EPI 方程估算更昔洛韦清除率。
Comparison of the Cockcroft-Gault, MDRD and CKD-EPI equations for estimating ganciclovir clearance.
机构信息
Department of Pharmacy, Vall d'Hebron University Hospital, Barcelona, Spain.
Department of Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain.
出版信息
Br J Clin Pharmacol. 2018 Sep;84(9):2120-2128. doi: 10.1111/bcp.13647. Epub 2018 Jul 8.
AIMS
Accurately estimating kidney function is essential for the safe administration of renally cleared drugs such as ganciclovir. Current practice recommends adjusting renally eliminated drugs according to the Cockcroft-Gault equation. There are no data on the utility of the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in ganciclovir dosing. To evaluate which renal function equation best predicts ganciclovir clearance.
METHODS
The performance of the Cockcroft-Gault equation, isotope dilution mass spectrometry (IDMS)-traceable 4-variable MDRD study (MDRD4-IDMS) equation and CKD-EPI equation in determining ganciclovir clearance were assessed retrospectively in patients treated with ganciclovir from 2004-2015. The MDRD4-IDMS and CKD-EPI equations adjusted to individual body surface area (MDRD4-IDMS·BSA and CKD-EPI·BSA, respectively) were also evaluated. Patients with intravenous ganciclovir peak and trough concentrations in their medical records were included in the study. Ganciclovir clearance was calculated from serum concentrations using a one-compartment model. The five equations were compared based on their predictive ability, the coefficient of determination, through a linear regression analysis. The results were validated in a group of patients.
RESULTS
One hundred patients were included in the final analysis. Seventy-four patients were analysed in the learning group and 26 in the validation group. The coefficient of determination was 0.281 for Cockcroft-Gault, 0.301 for CKD-EPI·BSA, 0.308 for MDRD4-IDMS·BSA, 0.324 for MDRD4-IDMS and 0.360 for CKD-EPI. Subgroup analysis also showed that CKD-EPI is a better predictor of ganciclovir clearance. Analysis of the validation group confirmed these results.
CONCLUSIONS
The CKD-EPI equation correlates better with ganciclovir clearance than the Cockcroft-Gault and MDRD4-IDMS equations, even the clinical difference between the equations is scarce.
目的
准确评估肾功能对于安全使用经肾脏清除的药物（如更昔洛韦）至关重要。目前的实践建议根据 Cockcroft-Gault 方程调整经肾脏消除的药物。关于 Modification of Diet in Renal Disease（MDRD）和 Chronic Kidney Disease Epidemiology Collaboration（CKD-EPI）方程在更昔洛韦剂量中的应用，尚无数据。评估哪种肾功能方程最能预测更昔洛韦清除率。
方法
回顾性评估 2004 年至 2015 年接受更昔洛韦治疗的患者中，Cockcroft-Gault 方程、同位素稀释质谱法（IDMS）-可溯源 4 变量 MDRD 研究（MDRD4-IDMS）方程和 CKD-EPI 方程在确定更昔洛韦清除率方面的性能。还评估了针对个体体表面积调整的 MDRD4-IDMS 方程（MDRD4-IDMS·BSA）和 CKD-EPI 方程（CKD-EPI·BSA）。本研究纳入了病历中有静脉更昔洛韦峰浓度和谷浓度的患者。使用一室模型从血清浓度计算更昔洛韦清除率。通过线性回归分析比较了这 5 种方程的预测能力，即决定系数。在一组患者中验证了结果。
结果
最终分析纳入 100 例患者。74 例患者在学习组中进行分析，26 例患者在验证组中进行分析。Cockcroft-Gault 的决定系数为 0.281，CKD-EPI·BSA 的决定系数为 0.301，MDRD4-IDMS·BSA 的决定系数为 0.308，MDRD4-IDMS 的决定系数为 0.324，CKD-EPI 的决定系数为 0.360。亚组分析还表明，CKD-EPI 是更昔洛韦清除率的更好预测指标。验证组的分析结果证实了这些结果。
结论
与 Cockcroft-Gault 和 MDRD4-IDMS 方程相比，CKD-EPI 方程与更昔洛韦清除率的相关性更好，即使这些方程之间的临床差异很小。
Zotero 插件