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Predictors of Discrepancies Between Cockcroft-Gault and Chronic Kidney Disease-EPI Creatinine-Cystatin in

Savannah S Poole1, Audis Bethea1, Eden Brewington1

  • 1Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.

The Annals of Pharmacotherapy
|August 27, 2025
PubMed

Insights

The Cockcroft-Gault equation may overestimate renal function compared to CKD-EPI creatinine-cystatin C in hospitalized patients. Key predictors of this discrepancy include younger age, higher weight, ICU admission, and paralysis.

Area of Science:

  • Nephrology
  • Clinical Chemistry

Background:

  • Cockcroft-Gault (eCrCl) is standard for estimating renal function but has limitations.
  • CKD-EPI creatinine-cystatin C (eGFRcr-cys) offers improved accuracy in certain settings.

Purpose of the Study:

  • Identify patient-specific factors associated with a significant difference (>25 mL/min) where eCrCl exceeds eGFRcr-cys.
  • Determine the predictive value of these patient characteristics.

Main Methods:

  • Retrospective observational study of adult inpatients with paired creatinine and cystatin C measurements.
  • Exclusion criteria included pregnancy and renal replacement therapy.
  • Multivariate regression analysis to identify predictors of eCrCl/eGFRcr-cys discrepancy.

Main Results:

  • 67 out of 235 encounters showed a >25 mL/min difference favoring eCrCl.
  • Independent predictors identified: age <58 years, weight >105 kg, ICU admission, and paraplegia/quadriplegia.
  • Significant odds ratios were calculated for each predictor.

Conclusions:

  • eCrCl may overestimate renal function by >25 mL/min in hospitalized patients with specific characteristics.
  • Younger age, higher weight, ICU admission, or paralysis are associated with this overestimation.
  • Clinicians should consider using eGFRcr-cys for renal function assessment in these patients.
Abstract

Keywords:
Cockcroft Gaultchronic kidney disease-EPIcreatininecreatinine clearancecystatin C

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