[How to estimate glomerular filtration rate in the context of drug dosage adaptation ?]

In chronic kidney disease (CKD) patients, the dosage of many medications should be adapted according to the glomerular filtration rate (GFR). GFR estimation is obtained by using creatinine-based equations. Many different equations have been proposed in the literature, and they don't systematically lead to the same result in terms of drug dosage. There is an ongoing debate to determine which equations should be recommended, with the Cockcroft equation on one side and the MDRD (« Modified Diet in Renal Diseases ») or CKD-EPI (« Chronic Kidney Disease Epidemiology ») on the other side. The last two equations are especially used by nephrologists whereas the Cockcroft is still considered by geriatrists and pharmacologists. In the current article, we discuss the pro/cons from both sides, and propose recommendation for the clinical practice.