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J. Clin. Med. 2018, 7(8), 211; https://doi.org/10.3390/jcm7080211

Use of Estimating Equations for Dosing Antimicrobials in Patients with Acute Kidney Injury Not Receiving Renal Replacement Therapy

1
Division of Clinical Pharmacy, UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA 92093, USA
2
Department of Medicine, Division of Nephrology, UCSD School of Medicine, San Diego, CA 92093, USA
3
Department of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
4
Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94034, USA
*
Author to whom correspondence should be addressed.
Received: 17 July 2018 / Revised: 2 August 2018 / Accepted: 7 August 2018 / Published: 11 August 2018
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Abstract

Acute kidney injury (AKI) can potentially lead to the accumulation of antimicrobial drugs with significant renal clearance. Drug dosing adjustments are commonly made using the Cockcroft-Gault estimate of creatinine clearance (CLcr). The Modified Jelliffe equation is significantly better at estimating kidney function than the Cockcroft-Gault equation in the setting of AKI. The objective of this study is to assess the degree of antimicrobial dosing discordance using different glomerular filtration rate (GFR) estimating equations. This is a retrospective evaluation of antimicrobial dosing using different estimating equations for kidney function in AKI and comparison to Cockcroft-Gault estimation as a reference. Considering the Cockcroft-Gault estimate as the criterion standard, antimicrobials were appropriately adjusted at most 80.7% of the time. On average, kidney function changed by 30 mL/min over the course of an AKI episode. The median clearance at the peak serum creatinine was 27.4 (9.3–66.3) mL/min for Cockcroft Gault, 19.8 (9.8–47.0) mL/min/1.73 m2 for MDRD and 20.5 (4.9–49.6) mL/min for the Modified Jelliffe equations. The discordance rate for antimicrobial dosing ranged from a minimum of 8.6% to a maximum of 16.4%. In the event of discordance, the dose administered was supra-therapeutic 100% of the time using the Modified Jelliffe equation. Use of estimating equations other than the Cockcroft Gault equation may significantly alter dosing of antimicrobials in AKI. View Full-Text
Keywords: acute kidney injury; Cockcroft Gault; Jelliffe; MDRD; drug dosing; antimicrobials acute kidney injury; Cockcroft Gault; Jelliffe; MDRD; drug dosing; antimicrobials
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Awdishu, L.; Connor, A.I.; Bouchard, J.; Macedo, E.; Chertow, G.M.; Mehta, R.L. Use of Estimating Equations for Dosing Antimicrobials in Patients with Acute Kidney Injury Not Receiving Renal Replacement Therapy. J. Clin. Med. 2018, 7, 211.

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