Creatinine Clearance Is Not Equal to Glomerular Filtration Rate and Cockcroft-Gault Equation Is Not Equal to CKD-EPI Collaboration Equation.
Direct oral anticoagulants (DOACs) may require dose reduction or avoidance when glomerular filtration rate is low. However, glomerular filtration rate is not usually measured in routine clinical practice. Rather, equations that incorporate different variables use serum creatinine to estimate either creatinine clearance in mL/min or glomerular filtration rate in mL/min/1.73 m2. The Cockcroft-Gault equation estimates creatinine clearance and incorporates weight into the equation. By contrast, the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate and incorporate ethnicity but not weight. As a result, an individual patient may have very different renal function estimates, depending on the equation used. We now highlight these differences and discuss the impact on routine clinical care for anticoagulation to prevent embolization in atrial fibrillation. Pivotal DOAC clinical trials used creatinine clearance as a criterion for patient enrollment, and dose adjustment and Federal Drug Administration recommendations are based on creatinine clearance. However, clinical biochemistry laboratories provide CKD-EPI glomerular filtration rate estimations, resulting in discrepancies between clinical trial and routine use of the drugs.
IIS-Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Spain; REDINREN, Madrid, Spain.
Raul
R
Fernandez-Prado
IIS-Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Spain; REDINREN, Madrid, Spain.
Esmeralda
E
Castillo-Rodriguez
IIS-Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Spain.
Fernando Javier
FJ
Velez-Arribas
IIS-Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Spain; REDINREN, Madrid, Spain; Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain.
Carolina
C
Gracia-Iguacel
IIS-Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Spain; REDINREN, Madrid, Spain; Fundación Renal Iñigo Alvarez de Toledo-IRSIN, Madrid, Spain. Electronic address: aortiz@fjd.es.
Alberto
A
Ortiz
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D003404:Creatinine / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods / Q000592:standards*; D010818:Practice Patterns, Physicians'; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*
D000925:Anticoagulants; D003404:Creatinine
Atrial fibrillation; Chronic kidney disease; Creatinine clearance; Glomerular filtration rate; Oral anticoagulation