PDF(Pubmed)
Abstract：
Introduction: Adjusting drug dose levels based on equations that standardize the estimated glomerular filtration rate (eGFR) to a body surface area (BSA) of 1.73 m2 can pose challenges, especially for patients with extremely high or low body mass index (BMI). The objective of the present study of patients with CKD and diabetes was to assess the impact of deindexing creatinine-based equations on estimates of kidney function and on the frequency of inappropriate prescriptions of oral antidiabetic drugs (OADs). Methods: The prospective CKD-REIN cohort is comprised of patients with eGFR <60 mL/min/1.73 m2. The inclusion criteria for this study were the use of OADs and the availability of data on weight, height and serum creatinine. We compared data for three BMI subgroups (group 1 <30 kg/m2; group 2 30-34.9 kg/m2; group 3 ≥35 kg/m2). Inappropriate prescriptions (contraindicated or over-dosed drugs) were assessed with regard to the summary of product characteristics and the patient\'s kidney function estimated with the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the 2021 CKD-EPI equation, the Modification of Diet in Renal Disease (MDRD) equation, the European Kidney Function Consortium (EKFC) equation, their deindexed estimates, and the Cockcroft-Gault (CG) formula. The impact of deindexing the equations was evaluated by assessing 1) the difference between the indexed and deindexed eGFRs, and 2) the difference in the proportion of patients with at least one inappropriate OAD prescription between the indexed and deindexed estimates. Results: At baseline, 694 patients were receiving OADs. The median BMI was 30.7 kg/m2, the mean BSA was 1.98 m2, and 90% of patients had a BSA >1.73 m2. Deindexing the kidney function estimates led to higher eGFRs, especially in BMI group 3. The proportion of patients with at least one inappropriate prescription differed greatly when comparing indexed and deindexed estimates. The magnitude of the difference increased with the BMI: when comparing BMI group 1 with BMI group 3, the difference was respectively -4% and -10% between deindexed 2021 CKD-EPI and indexed CKD-EPI. Metformin and sitagliptin were the most frequent inappropriately prescribed OADs. Conclusion: We highlight significant differences between the BSA-indexed and deindexed versions of equations used to estimate kidney function, emphasizing the importance of using deindexed estimates to adjust drug dose levels - especially in patients with an extreme BMI.
摘要：
简介：根据将估计的肾小球滤过率（eGFR）标准化为1.73m2的体表面积（BSA）的方程式调整药物剂量水平可能会带来挑战，特别是对于体重指数（BMI）极高或极低的患者。本研究针对CKD和糖尿病患者的目的是评估基于肌酐的方程对肾功能估计和口服抗糖尿病药物（OADs）不适当处方频率的影响。方法：前瞻性CKD-REIN队列由eGFR<60mL/min/1.73m2的患者组成。这项研究的纳入标准是OAD的使用和体重数据的可用性，身高和血清肌酐。我们比较了三个BMI亚组的数据（第1组<30kg/m2；第2组30-34.9kg/m2；第3组≥35kg/m2）。根据2009年慢性肾脏病流行病学合作（CKD-EPI）公式评估产品特征和患者肾功能的总结，评估了不适当的处方（禁忌或过量用药）。2021年CKD-EPI方程，肾脏疾病饮食（MDRD）方程的修改，欧洲肾功能联盟(EKFC)方程，他们的去指数估计，和Cockcroft-Gault(CG)公式。通过评估1)索引和去索引的eGFRs之间的差异来评估方程去索引的影响，和2）索引估计值和去索引估计值之间至少有一个不适当的OAD处方的患者比例差异。结果：在基线，694名患者接受OADs。BMI中位数为30.7kg/m2，平均BSA为1.98m2，90%的患者BSA>1.73m2。降低肾功能估计值导致更高的eGFRs，尤其是BMI3组。比较索引估计值和去索引估计值时，至少有一个不适当处方的患者比例差异很大。差异的大小随BMI的增加而增加：将BMI组1与BMI组3进行比较时，去索引的2021CKD-EPI和索引的CKD-EPI之间的差异分别为-4％和-10％。二甲双胍和西格列汀是最常见的不当处方OAD。结论：我们强调了用于估计肾功能的BSA索引和去索引版本之间的显着差异，强调使用去指数化的估计值来调整药物剂量水平的重要性-特别是在具有极端BMI的患者中。
