title: Use of glomerular filtration rate estimating equations for drug dosing in HIV-positive patients.
abstract: BACKGROUND
  Current HIV treatment guidelines recommend using the Cockcroft-Gault equation for drug dosing adjustments. The use of newer glomerular filtration rate (GFR) estimating equations for drug dosing and the appropriateness of physician antiretroviral dosing based on estimated kidney function have not been studied in an HIV-positive population.
  
  
  METHODS
  We evaluated concordance between measured and estimated GFR for the assignment of kidney function categories designated by the US Food and Drug Administration (FDA) Guidance for industry for pharmacokinetic studies, and appropriateness of physician antiretroviral drug dosing for level of kidney function in 200 HIV-positive patients on stable antiretroviral therapy. Estimated kidney function was determined using the Chronic Kidney Disease-Epidemiology collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study and Cockcroft-Gault equations.
  
  
  RESULTS
  For assignment of FDA-designated kidney function categories, concordance rates between measured and estimated GFR using the CKD-EPI, MDRD Study and Cockcroft-Gault equations were 79%, 71% and 77%, respectively. This pattern was consistent across most subgroups. When actual prescribed dosages were compared with recommended dosages based on the level of estimated kidney function, 3-19% of study participants were prescribed higher than recommended dosages. The largest discordance between prescribed and recommended dosages was observed for the Cockcroft-Gault equation.
  
  
  CONCLUSIONS
  The CKD-EPI equation has the highest concordance with measured GFR for the assignment of FDA-designated kidney function categories. Its use may lead to lower dosing-related errors in HIV-infected US adults on stable antiretroviral therapy. More education is required with respect to dose adjustment for level of kidney function.
authors: Department of Medicine, Tufts Medical Center, Boston, MA, USA.
authors: Aghogho A
authors: AA
authors: Okparavero
authors: Hocine
authors: H
authors: Tighiouart
authors: Zipporah
authors: Z
authors: Krishnasami
authors: Christina M
authors: CM
authors: Wyatt
authors: Hiba
authors: H
authors: Graham
authors: James
authors: J
authors: Hellinger
authors: Lesley A
authors: LA
authors: Inker
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
references: Nephrol Dial Transplant. 2007 Oct;22(10):2894-9
references: 17575316
references: Sex Health. 2011 Dec;8(4):485-92
references: 22127033
references: AIDS. 2012 Sep 10;26(14):1781-8
references: 22713478
references: Am J Med Sci. 2008 Feb;335(2):89-94
references: 18277114
references: Ann Intern Med. 2012 Jun 5;156(11):785-95, W-270, W-271, W-272, W-273, W-274, W-275, W-276, W-277,
references: 22312131
references: Clin J Am Soc Nephrol. 2011 Jul;6(7):1700-7
references: 21566114
references: Antiviral Res. 2010 Dec;88(3):347-54
references: 20887753
references: Ann Intern Med. 2009 May 5;150(9):604-12
references: 19414839
references: Clin Pharmacol Ther. 2009 Nov;86(5):465-7
references: 19844220
references: Nephron Clin Pract. 2009;111(1):c39-48
references: 19052469
references: Ann Pharmacother. 2008 Dec;42(12):1758-65
references: 19047358
references: Am J Kidney Dis. 2010 Sep;56(3):486-95
references: 20557989
references: Clin Infect Dis. 2005 Jun 1;40(11):1559-85
references: 15889353
references: Scand J Clin Lab Invest. 1972 Nov;30(3):271-4
references: 4629674
references: J Am Soc Nephrol. 2009 Nov;20(11):2305-13
references: 19833901
references: Clin Infect Dis. 2009 Sep 1;49(5):651-81
references: 19640227
references: Ann Pharmacother. 2012 Apr;46(4):477-83
references: 22474135
references: Curr Opin Nephrol Hypertens. 2006 May;15(3):276-84
references: 16609295
references: Kidney Int. 2006 Jun;69(11):2070-7
references: 16612328
references: Am J Kidney Dis. 2009 Jul;54(1):33-42
references: 19446939
references: Pharmacotherapy. 2010 Oct;30(10):1004-10
references: 20874037
references: Curr Opin Nephrol Hypertens. 2010 May;19(3):298-307
references: 20393287
references: Clin Chem Lab Med. 2009;47(9):1017-9
references: 19728841
references: J Nephrol. 2012 Jul-Aug;25(4):515-22
references: 21928236
references: Ann Intern Med. 2006 Aug 15;145(4):247-54
references: 16908915
references: N Engl J Med. 2012 Jul 5;367(1):20-9
references: 22762315
references: Pharmacotherapy. 2008 Sep;28(9):1125-32
references: 18752383
references: J Am Coll Cardiol. 2008 Mar 11;51(10):991-6
references: 18325437
references: Pharmacotherapy. 2009 Jun;29(6):649-55
references: 19476418
references: Antivir Ther. 2008;13(6):761-70
references: 18839777
references: Nephron. 1976;16(1):31-41
references: 1244564
references: J Acquir Immune Defic Syndr. 2012 Nov 1;61(3):302-9
references: 22842844
references: Am J Health Syst Pharm. 2009 Jan 15;66(2):154-61
references: 19139480
references: J Am Soc Nephrol. 2007 Oct;18(10):2749-57
references: 17855641
references: Gynecol Oncol. 2006 Dec;103(3):1063-9
references: 16875719
references: Clin Nephrol. 2012 Apr;77(4):311-20
references: 22445475
references: Kidney Int. 2011 Dec;80(11):1122-37
references: 21918498
references: J Acquir Immune Defic Syndr. 2011 Aug 15;57(5):380-6
references: 21646913
references: Ann Pharmacother. 2006 Jul-Aug;40(7-8):1248-53
references: 16835312