St Peter Wendy L, Bzowyckyj Andrew S, Anderson-Haag Tracy, Awdishu Linda, Blackman Michael, Bland Andrew, Chan Ethan, Chmielewski Christine, Delgado Cynthia, Eyler Rachel, Foster Charles, Hudson Joanna, Kane-Gill Sandra L, Kliethermes Mary Ann, Le Tuan, Madabushi Rajanikanth, Martin Brianna, Miller W Greg, Neumiller Joshua J, Philbrick Ann M, Roberts Glenda, Schandorf Venita, Webb Andrew J, Wu Dennis, Nolin Thomas D
Am J Health Syst Pharm. 2025 Jun 11;82(12):644-659. doi: 10.1093/ajhp/zxae317.
The goals of this paper are to (1) provide evidence and expert consensus to support a unified approach to estimating kidney filtration in adults with stable kidney function using race-free estimated glomerular filtration rate (eGFR) in place of Cockcroft-Gault estimated creatinine clearance (C-G eCrCL) for medical and medication-related decisions, and (2) demonstrate how adjusting eGFR results for an individual's body surface area (BSA) when it is higher or lower than 1.73 m2 will improve results for medication-related decisions.
C-G eCrCL is predominantly used by US pharmacists to determine eGFR for the purposes of medication-related decisions, even though more accurate eGFR equations exist. Several driving factors make it the ideal time to shift clinical practice from using C-G eCrCL to eGFR. These factors include the following: (1) 2024 Food and Drug Administration (FDA) guidance for industry recommends eGFR over C-G eCrCL to evaluate the impact on pharmacokinetics in patients with impaired kidney function; (2) a joint National Kidney Foundation (NKF) and American Society of Nephrology task force recommends 3 race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR equations for medical and medication-related decision-making; (3) the almost ubiquitous use of standardized serum creatinine assay methods in US clinical laboratories; and (4) increasing availability and use of serum cystatin C for eGFR assessment. This publication guides practitioners through the rationale for using race-free eGFR equations for medication-related decisions and how to implement this practice change.
The NKF Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions suggests that health systems, health settings, clinical laboratories, electronic health record systems, compendia and data vendors, and healthcare practitioners involved with medication-related decision-making transition away from C-G eCrCL and towards the race-free eGFR equations for more accurate assessment of kidney filtration and consistency in medication and medical decision-making across the US.
本文的目标是：（1）提供证据和专家共识，以支持采用统一方法，使用无种族估计肾小球滤过率（eGFR）替代Cockcroft-Gault估计肌酐清除率（C-G eCrCL）来评估肾功能稳定的成年人的肾脏滤过功能，用于医疗和药物相关决策；（2）证明当个体体表面积（BSA）高于或低于1.73 m²时，调整eGFR结果如何能改善药物相关决策的结果。
尽管存在更准确的eGFR方程，但美国药剂师在进行药物相关决策时主要使用C-G eCrCL来确定eGFR。有几个驱动因素使得现在是将临床实践从使用C-G eCrCL转向eGFR的理想时机。这些因素包括：（1）2024年美国食品药品监督管理局（FDA）发布的行业指南建议使用eGFR而非C-G eCrCL来评估肾功能受损患者的药代动力学影响；（2）美国国家肾脏基金会（NKF）和美国肾脏病学会联合工作组推荐使用3个无种族的慢性肾脏病流行病学协作组（CKD-EPI）eGFR方程进行医疗和药物相关决策；（3）美国临床实验室几乎普遍使用标准化血清肌酐检测方法；（4）血清胱抑素C用于eGFR评估的可用性和使用量不断增加。本出版物指导从业者了解使用无种族eGFR方程进行药物相关决策的基本原理以及如何实施这一实践变革。
NKF基于无种族eGFR的药物相关决策实施工作组建议，涉及药物相关决策的卫生系统、医疗机构、临床实验室、电子健康记录系统、药典和数据供应商以及医疗从业者，应从C-G eCrCL转向无种族eGFR方程，以便更准确地评估肾脏滤过功能，并使美国各地的药物和医疗决策保持一致。
