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New serum creatinine assay standardization: implications for drug dosing
William E Wade1, William J Spruill
1Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA 30602, USA. bwade@mail.rx.uga.edu
The Annals of Pharmacotherapy
|March 8, 2007
Summary
New serum creatinine assay standards offer greater accuracy but may lower drug dosing values. Clinicians may need to adjust results by 5-20% to match older drug manufacturer data for renal insufficiency.
Area of Science:
- Clinical Chemistry
- Pharmacology
- Nephrology
Background:
- Current serum creatinine assays lack standardization, leading to variability in results.
- The National Kidney Foundation recommends assay calibration for improved accuracy.
Purpose of the Study:
- To describe the development of new serum creatinine assay standards.
- To discuss the implications of these new standards for drug dosing in patients with renal insufficiency.
Main Methods:
- MEDLINE literature search (1990-August 2006).
- Extraction of data on new creatinine assay procedures and their impact on drug dosing.
Main Results:
- New standards aim for increased assay accuracy, potentially lowering normal and patient serum creatinine values by 5-20%.
- Lower creatinine values lead to higher estimated glomerular filtration rates and creatinine clearance (Cl(cr)).
- This discrepancy poses challenges for applying current drug dosing guidelines based on older creatinine values.
Conclusions:
- Worldwide adoption of new serum creatinine calibration standards will yield more accurate patient values.
- Higher Cl(cr) estimates may not align with drug manufacturers' established dosing tables.
- Clinicians may need to adjust new assay results by 5-20% to approximate older values for accurate drug dosage adjustments in renal insufficiency.
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