title: [Dosing adjustment and renal function: Which equation(s)?].
abstract: While the CKD-EPI (for Chronic Kidney Disease Epidemiology) equation is now implemented worldwide, utilization of the Cockcroft formula is still advocated by some physicians for drug dosage adjustment. Justifications for this recommendation are that the Cockcroft formula was preferentially used to determine dose adjustments according to renal function during the development of many drugs, better predicts drugs-related adverse events and decreases the risk of drug overexposure in the elderly. In this opinion paper, we discuss the weaknesses of the rationale supporting the Cockcroft formula and endorse the French HAS (Haute Autorité de santé) recommendation regarding the preferential use of the CKD-EPI equation. When glomerular filtration rate (GFR) is estimated in order to adjust drug dosage, the CKD-EPI value should be re-expressed for the individual body surface area (BSA). Given the difficulty to accurately estimate GFR in the elderly and in individuals with extra-normal BSA, we recommend to prescribe in priority monitorable drugs in those populations or to determine their "true" GFR using a direct measurement method.
authors.affiliation: Service de néphrologie, dialyse et transplantation, CHU Sart-Tilman, université de Liège, 4000 Liège, Belgique.
authors.forename: Pierre
authors.initials: P
authors.lastname: Delanaye
authors.affiliation: Service d'explorations fonctionnelles, hôpital Bichat, AP-HP, université Paris Diderot, Paris, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Flamant
authors.affiliation: Service de chimie clinique, CHU Sart-Tilman, université de Liège, 4000 Liège, Belgique.
authors.forename: Étienne
authors.initials: É
authors.lastname: Cavalier
authors.affiliation: Laboratoire Oriade-Vizille, 75, chemin de la Terrasse, 38220 Vizille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Guerber
authors.affiliation: Laboratoire Vialle, Bastia et Syndicat des jeunes biologistes médicaux, 20600 BastiaFrance.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vallotton
authors.affiliation: EA 2415, biostatistique, épidémiologie et santé publique, institut universitaire de recherche clinique, université de Montpellier, 34093 Montpellier, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Moranne
authors.affiliation: Department of Primary Care and Public Health at Kulak, KU Leuven Kulak, 8500 Kortrijk, Belgique.
authors.forename: Hans
authors.initials: H
authors.lastname: Pottel
authors.affiliation: Inserm 1155, service de néphrologie et dialyse, hôpital Tenon, AP-HP, université Pierre-et-Marie-Curie, 75020 Paris, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Boffa
authors.affiliation: Service de néphrologie, dialyse et transplantation, hôpital Nord, CHU de Saint-Étienne, université Jean-Monnet, 42055 Saint-Étienne, France. Electronic address: christophe.mariat@univ-st-etienne.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariat
mesh_terms: D054796:Drug Dosage Calculations; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology
keywords: Adaptation posologique; CKD-EPI; Cockcroft; Dosage adjustment