Drug Dosing and Estimated Renal Function - Any Step Forward from Effersoe?

Area of Science:

• Nephrology
• Clinical Pharmacology
• Pharmacokinetics

Background:

• Accurate drug dosing based on renal function is a persistent clinical challenge.
• Existing formulas for estimating glomerular filtration rate (GFR) have significant limitations.
• Many drugs are primarily cleared by the kidneys, necessitating precise dosing adjustments.

Purpose of the Study:

• To review the challenges of estimating renal function for drug dosing.
• To evaluate the limitations of current estimated GFR (eGFR) formulas.
• To discuss the implications of using eGFR in clinical practice and research.

Main Methods:

• Review of existing creatinine- and cystatin C-based GFR estimation formulas.
• Analysis of the shortcomings of these formulas in diverse clinical scenarios.
• Discussion of the use of eGFR as a clinical endpoint and its potential for misinterpretation.

Main Results:

• No current eGFR formula adequately performs across all clinical situations.
• The use of eGFR as a hard clinical endpoint can lead to unsupported conclusions.
• Significant discrepancies exist between estimated and measured GFR (mGFR).

Conclusions:

• Estimated GFR (eGFR) has serious limitations for safe drug dosing and clinical research.
• Clinicians and researchers must be aware of eGFR's shortcomings.
• Further research into accurate renal function assessment for drug dosing is warranted.