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Pharmaceuticals 2018, 11(3), 88; https://doi.org/10.3390/ph11030088

Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients

1
Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark
2
The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark
3
Section of Pharmacotherapy, Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
4
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7, building A2-206, 9220 Aalborg Ø, Denmark
5
Orthopedic Department, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark
6
Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Enterance B, 2nd floor, 1014 København, Denmark
7
Emergency Department, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 436, 2650 Hvidovre, Denmark
*
Author to whom correspondence should be addressed.
Received: 22 August 2018 / Revised: 13 September 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
(This article belongs to the Special Issue Choices of the Journal)
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Abstract

Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not developed for use in the elderly, while the recent Berlin Initiative Study (BIS), Full Age Spectrum (FAS), and Lund-Malmö revised (LMR) equations are. This observational study investigated differences between creatinine-based eGFR equations and how the choice of equation influences dosage of analgesics in elderly (≥70 years) patients admitted with acute hip fracture. eGFR was calculated by the CKD-EPI, BIS, Cockcroft-Gault (CG), FAS, LMR, and Modification of Diet in Renal Disease (MDRD) equations. Standard daily dose for postoperative pain medications ibuprofen, morphine and gabapentin was simulated for each equation according to dosage recommendations in Renbase®. For 118 patients, mean eGFR from the CKD-EPI, BIS, CG, FAS, LMR, and MDRD equations was 67.3 mL/min/1.73 m2, 59.1 mL/min/1.73 m2, 56.9 mL/min/1.73 m2, 60.3 mL/min/1.73 m2, 58.9 mL/min/1.73 m2, and 79.1 mL/min/1.73 m2, respectively (p < 0.0001). Mean difference to CKD-EPI was −10.4 mL/min/1.73 m2 to 11.8 mL/min/1.73 m2. Choice of eGFR equation significantly influenced the recommended dose (p < 0.0001). Shifting to BIS, FAS, or LMR equations led to a lower recommended dose in 20% to 31% of patients. Choice of eGFR equation significantly influenced dosing of ibuprofen, morphine, and gabapentin. View Full-Text
Keywords: renal function; kidney function; glomerular filtration rate; elderly; analgesic; pain management; drug dose adjustment; drug dosing; patient safety; clinical pharmacy renal function; kidney function; glomerular filtration rate; elderly; analgesic; pain management; drug dose adjustment; drug dosing; patient safety; clinical pharmacy
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Houlind, M.B.; Petersen, K.K.; Palm, H.; Jørgensen, L.M.; Aakjær, M.; Christrup, L.L.; Petersen, J.; Andersen, O.; Treldal, C. Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients. Pharmaceuticals 2018, 11, 88.

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