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Related Concept Videos

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

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In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
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Renal Failure: Dose Adjustments01:11

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

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Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
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Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

340
In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance...
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Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate01:25

Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate

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The glomerular filtration rate (GFR) is a critical indicator of kidney health, reflecting how well the kidneys filter blood. Changes in GFR can signal potential kidney impairment, necessitating accurate measurement methods to monitor kidney function effectively.Various molecules can serve as markers for GFR measurement, with the ideal marker meeting several specific criteria. It must freely filter at the glomerulus, avoid reabsorption or secretion by the renal tubules, remain unmetabolized, not...
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Drug Dosing: Infants and Children01:29

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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Related Experiment Video

Updated: Mar 29, 2026

Physiology Lab Demonstration: Glomerular Filtration Rate in a Rat
06:58

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[Dosing adjustment and renal function: Which equation(s)?].

Pierre Delanaye1, Martin Flamant2, Étienne Cavalier3

  • 1Service de néphrologie, dialyse et transplantation, CHU Sart-Tilman, université de Liège, 4000 Liège, Belgique.

Nephrologie & Therapeutique
|November 26, 2015
PubMed
Summary
This summary is machine-generated.

The CKD-EPI equation is preferred over the Cockcroft formula for drug dosing adjustments due to its accuracy. For elderly patients or those with unusual body size, monitorable drugs or direct GFR measurement are recommended.

Keywords:
Adaptation posologiqueCKD-EPICockcroftDosage adjustment

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Area of Science:

  • Nephrology
  • Clinical Pharmacology
  • Drug Dosing

Background:

  • The Cockcroft formula is still used by some physicians for drug dosage adjustments.
  • Justifications include its historical use in drug development and prediction of adverse events.

Purpose of the Study:

  • To discuss the weaknesses of the Cockcroft formula's rationale.
  • To endorse the French HAS recommendation for the CKD-EPI equation.

Main Methods:

  • Literature review and expert opinion.
  • Analysis of the rationale behind using the Cockcroft formula versus CKD-EPI.

Main Results:

  • The Cockcroft formula has significant weaknesses in its supporting rationale.
  • CKD-EPI equation is recommended for estimating glomerular filtration rate (GFR).

Conclusions:

  • CKD-EPI equation should be preferentially used for GFR estimation in drug dosing.
  • GFR values should be re-expressed for individual body surface area (BSA).
  • For elderly or individuals with abnormal BSA, monitorable drugs or direct GFR measurement are advised.