Esben Iversen1,2, Ann Christine Bodilsen1,3, Henrik Hedegaard Klausen1, Charlotte Treldal1,4, Ove Andersen1,5,6, Morten Baltzer Houlind1,2,4, Janne Petersen1,7,8. 1. Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark. 2. Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark. 3. Exercise and Health, Roskilde Municipality, Denmark. 4. Capital Region Pharmacy, Herlev, Denmark. 5. Emergency Department, Copenhagen University Hospital, Hvidovre, Denmark. 6. Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 7. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 8. Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark.
Abstract
BACKGROUND: Medication errors due to inaccurate measures of kidney function are common among elderly patients. We investigated differences between estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C and how these differences would affect prescribing recommendations among acutely hospitalized elderly patients. We also identified factors associated with discrepancies between estimates. METHODS: Estimated glomerular filtration rate and chronic kidney disease (CKD) classifications were determined for 338 acutely hospitalized elderly patients using equations from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Berlin Initiative Study (BIS) and Cockcroft-Gault (CG). Prescribed renal risk medications were compared with dosing guidelines in Renbase® . Linear regression models were used to identify explanatory variables for eGFR discrepancies between equations. Muscle weakness was assessed by handgrip strength; inflammation was assessed by smoking status, serum C-reactive protein (CRP), soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-associated lipocalin (NGAL); and organ dysfunction was assessed by thyroid-stimulating hormone (TSH) and FI-OutRef. RESULTS: Median eGFR values were 65.5, 60.7, 54.1, 57.1, 55.1 and 57.6 mL/min/1.73m2 according to CKD-EPICr , CKD-EPIComb , CKD-EPICys , BISCr , BISComb and CGCr , respectively. Depending on choice of equation, renal risk medications were prescribed at higher than recommended dose in 13.6% to 22.5% of patients using normalized GFR units and 9.9% to 19.1% of patients using absolute units. Age, handgrip strength, CRP, suPAR, NGAL and smoking status had significant association with eGFR discrepancies between creatinine- and cystatin C-based equations. CONCLUSIONS: Significant discrepancies in eGFR and CKD classification were observed when switching between eGFR equations in acutely hospitalized elderly patients. Switching from a creatinine-based equation to its corresponding cystatin C-based equation resulted in lower GFR estimates, and these differences were larger than in community-dwelling older populations. Switching between CKD-EPICr , CGCr and the alternative equations would result in clinically relevant changes to medication prescribing. Discrepancies between equations were associated with high age, muscle weakness and inflammation.
BACKGROUND: Medication errors due to inaccurate measures of kidney function are common among elderly patients. We investigated differences between estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C and how these differences would affect prescribing recommendations among acutely hospitalized elderly patients. We also identified factors associated with discrepancies between estimates. METHODS: Estimated glomerular filtration rate and chronic kidney disease (CKD) classifications were determined for 338 acutely hospitalized elderly patients using equations from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Berlin Initiative Study (BIS) and Cockcroft-Gault (CG). Prescribed renal risk medications were compared with dosing guidelines in Renbase® . Linear regression models were used to identify explanatory variables for eGFR discrepancies between equations. Muscle weakness was assessed by handgrip strength; inflammation was assessed by smoking status, serum C-reactive protein (CRP), soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-associated lipocalin (NGAL); and organ dysfunction was assessed by thyroid-stimulating hormone (TSH) and FI-OutRef. RESULTS: Median eGFR values were 65.5, 60.7, 54.1, 57.1, 55.1 and 57.6 mL/min/1.73m2 according to CKD-EPICr , CKD-EPIComb , CKD-EPICys , BISCr , BISComb and CGCr , respectively. Depending on choice of equation, renal risk medications were prescribed at higher than recommended dose in 13.6% to 22.5% of patients using normalized GFR units and 9.9% to 19.1% of patients using absolute units. Age, handgrip strength, CRP, suPAR, NGAL and smoking status had significant association with eGFR discrepancies between creatinine- and cystatin C-based equations. CONCLUSIONS: Significant discrepancies in eGFR and CKD classification were observed when switching between eGFR equations in acutely hospitalized elderly patients. Switching from a creatinine-based equation to its corresponding cystatin C-based equation resulted in lower GFR estimates, and these differences were larger than in community-dwelling older populations. Switching between CKD-EPICr , CGCr and the alternative equations would result in clinically relevant changes to medication prescribing. Discrepancies between equations were associated with high age, muscle weakness and inflammation.
Authors: Morten Baltzer Houlind; Aino Leegaard Andersen; Charlotte Treldal; Lillian Mørch Jørgensen; Pia Nimann Kannegaard; Luana Sandoval Castillo; Line Due Christensen; Juliette Tavenier; Line Jee Hartmann Rasmussen; Mikkel Zöllner Ankarfeldt; Ove Andersen; Janne Petersen Journal: J Clin Med Date: 2020-01-27 Impact factor: 4.241