Hernandez Brandy N, Wieruszewski Patrick M, Barreto Jason N, Cole Kristin C, Damani Shivam, Kane-Gill Sandra L, Kashani Kianoush B, Kelly Ellen, Rule Andrew D, Teaford Hilary R, Zand Jaleh, Barreto Erin F
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Pharmacotherapy. 2024 Dec;44(12):898-906. doi: 10.1002/phar.4627. Epub 2024 Nov 27.
Accurately estimating glomerular filtration rate (GFR) is crucial for dosing medications in hospitalized patients. Due to limitations of serum creatinine for GFR estimation, serum cystatin C (CysC) has been explored as an alternative functional kidney biomarker. This study assessed discordance between eGFR and eGFR in a large sample of hospitalized patients and examined the frequency of renally eliminated medications affected by eGFR discordance.
This multisite historical study included adults hospitalized between 2011 and 2023 with CysC and serum creatinine reported within 24 h of each other. The first concurrent biomarker pair for each patient was analyzed. eGFR discordance and use of renally eliminated medications were described.
17,718 hospitalized patients with concurrent creatinine and CysC assessments were included. The median eGFR was 65 mL/min, and the eGFR was 46 mL/min. The median absolute difference of eGFR-eGFR was 15 mL/min, and 7972 patients (45%) had a > 30% absolute difference. There was a significantly greater percentage of patients with an eGFR <30 mL/min based on eGFR (26%) compared to eGFR (15%) (p < 0.001). Patients were prescribed an average of 20 medications in the 24 h surrounding the concurrent biomarker assessment. Renally eliminated medications accounted for 39% ± 13% of medication orders, and 80% of patients with eGFR discordance were prescribed five or more renally eliminated medications.
Substantial eGFR discordance between eGFR and eGFR was observed in hospitalized patients, which directly affects the dosing of renally eliminated medications. Further research is needed to optimize the pharmacotherapy of renally eliminated medications with discordant GFR assessments to improve medication safety and effectiveness.
准确估算肾小球滤过率（GFR）对于住院患者给药至关重要。由于血清肌酐在估算GFR方面存在局限性，血清胱抑素C（CysC）已被探索作为一种替代性的肾脏功能生物标志物。本研究评估了大量住院患者中估算肾小球滤过率（eGFR）与基于血清胱抑素C估算的肾小球滤过率（eGFR）之间的不一致性，并检查了受eGFR不一致影响的经肾脏排泄药物的使用频率。
这项多中心历史性研究纳入了2011年至2023年期间住院的成年人，他们的CysC和血清肌酐在彼此24小时内报告。分析了每位患者的第一对同时检测的生物标志物。描述了eGFR不一致情况以及经肾脏排泄药物的使用情况。
纳入了17718例同时进行肌酐和CysC评估的住院患者。eGFR的中位数为65毫升/分钟，基于血清胱抑素C估算的eGFR为46毫升/分钟。eGFR与基于血清胱抑素C估算的eGFR的中位数绝对差值为15毫升/分钟，7972例患者（45%）的绝对差值>30%。基于eGFR，eGFR<30毫升/分钟的患者比例（26%）显著高于基于血清胱抑素C估算的eGFR（15%）（p<0.001）。在同时检测生物标志物评估前后的24小时内，患者平均开具了20种药物。经肾脏排泄的药物占药物医嘱的39%±13%，80%的eGFR不一致患者开具了五种或更多经肾脏排泄的药物。
在住院患者中观察到eGFR与基于血清胱抑素C估算的eGFR之间存在显著的不一致性，这直接影响经肾脏排泄药物的给药剂量。需要进一步研究以优化GFR评估不一致时经肾脏排泄药物的药物治疗，以提高用药安全性和有效性。
