Pragmatic Use of Kidney Function Estimates for Drug Dosing

The Tide Is Turning

Joanna Laizure, Thomas D. Nolin

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Creatinine clearance has been the most common method of estimating kidney function for the purpose of drug dosing for decades. The availability and extensive clinical use of estimated glomerular filtration rate (eGFR) now provides clinicians a potential alternative. Currently, data demonstrating the validity of eGFR-based drug dosing is limited, but proof of principle has been established and the tide related to use of eGFR for drug dosing appears to be turning. Use of the same kidney function estimate for management of kidney disease, drug development and dosing, and harmonization in all clinical arenas would be ideal. Use of multiple equations can lead to differences in kidney function estimates and corresponding drug dosing regimens, which necessitates clinical judgment and a pragmatic approach when rendering drug dosing decisions. Careful consideration of the risk-benefit ratio of individual drugs and dosing regimens within each patient is warranted. Going forward, FDA guidance will likely incentivize pharmaceutical manufacturers to generate eGFR-based dosing recommendations in addition to creatinine clearance for inclusion in the label of newly approved drugs. However, dosing information for currently approved drugs will continue to be based on creatinine clearance alone, so clinicians must be vigilant in the assessment of kidney function in order to provide optimal pharmacotherapy.

Original languageEnglish (US)
Pages (from-to)14-20
Number of pages7
JournalAdvances in Chronic Kidney Disease
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2018

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Kidney
Pharmaceutical Preparations
Glomerular Filtration Rate
Creatinine
Kidney Diseases
Odds Ratio
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Pragmatic Use of Kidney Function Estimates for Drug Dosing : The Tide Is Turning. / Laizure, Joanna; Nolin, Thomas D.

In: Advances in Chronic Kidney Disease, Vol. 25, No. 1, 01.01.2018, p. 14-20.

Research output: Contribution to journalReview article

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