Renal Function
CrCl and eGFR are NOT interchangeable
As a hospital pharmacist, you can help colleagues determine the best way to estimate kidney function and adjust medications. Dosing based on estimated glomerular filtration rate (eGFR) is in labeling for more medications (meropenem/vaborbactam, baricitinib, etc). But CrCl and eGFR are NOT interchangeable, despite some guidance suggesting they are. Using eGFR when …
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Renal Function
eGFR and Creatinine clearance
Think with me ㅡ The physician is about to prescribe rivaroxaban ( Xarelto ) to someone with atrial fibrillation (AF). Their eGFR is 45. The recommended dose in AF is 20 mg once daily, but the dose should be reduced to 15 mg once daily if creatinine clearance is 15–49 mL/min. Should physician prescribe 15 or 20 mg? You decide you had better calculate the patient’s c…
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Renal Function
Expect a serum creatinine bump when starting an ACEI or ARB in kidney disease
How to safely use ACEIs or ARBs in patients with chronic kidney disease, this is an important question. We know these medications slow the progression of kidney disease. But blocking angiotensin can reduce kidney filtration and sometimes lead to a bump in serum creatinine (SCr) and potassium. See " Algorithm (1) of using ACEI or ARB after AKI ". …
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Renal Function
Don't use estimated GFR to renally dose all medications
The debate continues about whether to use creatinine clearance (CrCl) or estimated glomerular filtration rate (eGFR) for renal dosing. We used to just use the Cockcroft-Gault equation to calculate CrCl for renal dosing. But there's an increase in using eGFR calculated by the Modification of Diet in Renal Disease (MDRD) equation , such as in dosing recommen…
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