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PHC-024 Renal Function Estimation by Different Methods (CKD-EPI,Cockcroft-Gault and MDRD4-IDMS) and Its Effect on the Dose of IV Dexketoprofen
  1. M de Dios Garcia,
  2. C Salazar Valdebenito,
  3. M Alcalde Rodrigo,
  4. M Munné Garcia,
  5. I Cardona Pascual,
  6. JB Montoro Ronsano
  1. Hospital Universitari Vall d’Hebron, Pharmacy, Barcelona, Spain

Abstract

Background The different methods that currently exist to estimate renal function take into account different parameters, which may affect the dose of some drugs, such as dexketoprofen.

The recommended dose of IV dexketoprofen is 50 mg every 8 hours if eGFR is >80 mL/min/1.73 m², 25 mg every 12 hours if eGFR is between 50–80 mL/min/1.73 m² and it is contraindicated if eGFR is <50 mL/min/1.73 m² – according to the summary of product characteristics.

Purpose To determine the differences in the estimates of renal function, using CKD-EPI, MDRD4-IDMS and Cockcroft-Gault (CG) to estimate the glomerular filtration rate (eGFR) and to assess their effect on the functional characterization of patients and the dose of IV dexketoprofen.

Materials and Methods Retrospective observational study performed in adults admitted to surgical units – general, trauma and obstetric – treated with dexketoprofen IV in a tertiary hospital from January to September 2011 (9 months).

The eGFR was calculated by CKD-EPI, MDRD4-IDMS and Cockcroft-Gault. Patients with serum creatinine below 0.4 mg/dl were excluded.

CKD-EPI was used as a reference formula to assess the concordance between the different methods of estimating, classifying patients in 3 eGFR groups according to the IV dexketoprofen SmPC: <50 mL/min/1.73 m², 50–80 mL/min/1.73 m² and >80 mL/min/ 1.73 m².

Results The study included 1946 patients – 54.3% men, 45.7% women – from a total population of 2052 admissions; mean age of 59.8 years (range 17–103). The mean serum creatinine concentration was 0.84 mg/dL ± 0.43 and mean eGFR, according to CKD-EPI, 83.05 ± 26.17 mL/min/1.73 m².

The following results of non-concordance were found by comparing these formulas to estimate renal function:

  • CKD-EPI vs. MDRD4-IDMS: 4.3% in eGFR <50 mL/min/1.73 m² group, 23.2% in the eGFR 50–80 mL/min/1.73 m² and 18.9% in eGFR > 80 mL/min/1.73 m².

  • CKD-EPI vs. CG: 2.8% in eGFR <50 mL/min/1.73 m² group, 10.5% in eGFR 50–80 mL/min/1.73 m² and 7.8% in eGFR> 80 mL/min/1.73 m².

  • MDRD4-IDMS vs. CG: 4.5% in the group of eGFR < 50 ml/min, 21.4% in group eGFR 50–80 mL/min and 17.1% in the group of eGFR> 80 ml/min.

Conclusions A great difference was found in the estimates of renal function between the three methods used – CKD-EPI, MDRD4-IDMS and CG – in the three eGFR functional categories −<50, 50–80 and >80 mL/min/1.73 m² – ranging between 2.8% and 23.2%.

These results are relevant in clinical practise because the functional category determines the non-use or limited dose of dexketoprofen IV for each patient.

No conflict of interest.

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