title: Electronic estimations of renal function are inaccurate in solid-organ transplant recipients and can result in significant underdosing of prophylactic valganciclovir.
abstract: In a prospective study of solid-organ transplant recipients (n = 22; 15 hepatic and 7 renal) receiving valganciclovir for cytomegalovirus (CMV) prophylaxis, electronic estimation of glomerular filtration rate (eGFR) underestimated the true GFR (24-h urine creatinine clearance) by >20% in 14/22 (63.6%). Its use was associated with inappropriate underdosing of valganciclovir, while the Cockroft-Gault equation was accurate in 21/22 patients (95.4%). Subtherapeutic ganciclovir levels (≤ 0.6 mg/liter) were common, occurring in 10/22 patients (45.4%); 7 had severely deficient levels (<0.3 mg/liter).
authors.affiliation: Austin Health, Heidelberg, Victoria, Australia. Janine.trevillyan@monash.edu
authors.forename: J
authors.initials: J
authors.lastname: Trevillyan
authors.forename: P
authors.initials: P
authors.lastname: Angus
authors.forename: E
authors.initials: E
authors.lastname: Shelton
authors.forename: J
authors.initials: J
authors.lastname: Whitlam
authors.forename: F
authors.initials: F
authors.lastname: Ierino
authors.forename: J
authors.initials: J
authors.lastname: Pavlovic
authors.forename: D
authors.initials: D
authors.lastname: Gregory
authors.forename: K
authors.initials: K
authors.lastname: Urbancic
authors.forename: J
authors.initials: J
authors.lastname: Torresi
authors.forename: A
authors.initials: A
authors.lastname: Testro
authors.forename: M L
authors.initials: ML
authors.lastname: Grayson
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003401:Creatine / Q000652:urine; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000188:drug therapy; D001330:Electronic Data Processing; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D003401:Creatine; D015774:Ganciclovir