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Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

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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

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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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In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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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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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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Comparison of eGFR equations for estimating kidney function in Chinese children.

Junlong Hu1,2,3, Yan Yang1,2,3, Wenpin Ye1,2,3

  • 1Department of Pediatrics, The First Affiliated Hospital of Xiamen University, Xiamen, China.

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|December 1, 2025
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Accurate kidney function assessment in children is crucial. Combined creatinine, cystatin C, and BUN estimated GFR (eGFR) equations, specifically CKiD and Tang, show high accuracy and agreement with measured GFR (mGFR) in pediatric populations.

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Area of Science:

  • Pediatric Nephrology
  • Renal Function Biomarkers
  • Clinical Chemistry

Background:

  • Glomerular filtration rate (GFR) is essential for assessing kidney function in pediatric kidney diseases.
  • Existing estimated GFR (eGFR) equations lack validation in specific pediatric cohorts.
  • Accurate GFR measurement is vital for timely intervention and improved patient outcomes.

Purpose of the Study:

  • To evaluate and compare the performance of various eGFR equations against measured GFR (mGFR) in a pediatric population.
  • To identify the most accurate and precise eGFR equations for use in children.
  • To assess the utility of combined biomarker equations for eGFR estimation.

Main Methods:

  • Included 221 children in the study.
  • Compared 14 eGFR equations against mGFR using correlation, Bland-Altman analysis, bias, precision, and accuracy metrics.
  • Conducted subgroup analyses to further evaluate eGFR equation performance.

Main Results:

  • The CKiD (creatinine/cystatin C/blood urea nitrogen) and Tang (creatinine/cystatin C/blood urea nitrogen) equations showed no statistical difference from mGFR.
  • These combined equations exhibited the highest correlation, agreement, precision, and accuracy (P30 accuracies = 83.3% and 80.5%).
  • Latent profile analysis and subgroup analyses confirmed the superior performance of CKiD and Tang combined equations.

Conclusions:

  • eGFR equations incorporating creatinine (Cr), blood urea nitrogen (BUN), and cystatin C (CysC) simultaneously offer enhanced accuracy and precision.
  • The CKiD and Tang combined equations demonstrated the strongest correlation and agreement with mGFR.
  • These validated equations serve as reliable alternatives for estimating GFR when mGFR is unavailable in pediatric populations.