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Multiple Creatinine Clearance Methods

 

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Patient Name    Location:
Age:    Scr:     Sex:
Select serum creatinine reference standard:   [more info]
   
Height     Weight:
For MDRD equation. specify race:
Is the serum creatinine (Scr) currently stable:   
Restrict the maximum calculated clearance to this value








Creatinine Clearance methods

Cockcroft and Gault equation utilizing the tbw (Total body weight) to calculate an estimated CrCL

Cockcroft and Gault equation:
CrCl = [(140 - age) x TBW] / (Scr x 72) (x 0.85 for females)

Cockcroft and Gault equation utilizing the ibw (Ideal body weight) to calculate an estimated creatinine clearance

Cockcroft and Gault equation:
CrCl = [(140 - age) x IBW] / (Scr x 72) (x 0.85 for females)
Note: if the ABW (actual body weight) is less than the IBW use the
actual body weight for calculating the CRCL.

Estimate Ideal body weight in (kg)
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.

Cockcroft and Gault equation utilizing the adjusted body weight to calculate an estimated creatinine clearance.

CrCl = [(140 - age) x AjBW] / (Scr x 72)

Note: (Multiply result by 0.85 for females)
AjBW = adjusted body weight:
AjBW = IBW + 0.4( ABW - IBW)

Estimated IBW:
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.

Some studies have shown that utilizing the adjusted body weight improves accuracy compared to other commonly used equations in estimating the creatinine clearance in the elderly population.

Simplified 4-variable MDRD study formula

GFR = 186.3 x (SCR)-1.154  x  (age in years)-0.203  x  1.212 (if patient is black)  x 0.742 (if female)

Key point: Early statistical analysis shows very promising results. May represent the most accurate choice of this group. This may be especially true in chronic kidney disease.

References

  1. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16(1):31-41
  2. Davis GA, Chandler MH. Comparison of creatinine clearance estimation methods in patients with trauma. Am J Health-Syst Pharm 1996;53:1028-32.
  3. Dawson-Saunders B, Trapp RG. Basic and Clinical Biostatistics. 2nd ed. Norwalk, CT: Appleton & Lange; 1994.
  4. Demirovic JA, Pai AB, Pai MP. Estimation of creatinine clearance in morbidly obese patients. Am J Health Syst Pharm 2009; 66: 642-648 [PMID: 19299371 DOI: 10.2146/ajhp080200]
  5. Dettli LC. Drug dosage in patients with renal disease. Clin Pharmacol Ther 1974;16:274-80.
  6. Dooley MJ, Singh S, Rischin D. Rounding of low serum creatinine levels and consequent impact on accuracy of bedside estimates of renal function in cancer patients. Br J Cancer 2004; 90: 991-995 [PMID: 14997195 DOI: 10.1038/sj.bjc.6601641]
  7. Drusano LG, Munice HL, Hoopes JM et al. Commonly used methods of estimating creatinine clearance are inadequate for elderly debilitated nursing home patients. J Am Geriatrics Soc 1998;36:437-41.
  8. Hailemeskel B, Namanny M, Kurz A. Estimating aminoglycoside dosage requirements in patients with low serum creatinine concentrations. Am J Health-Syst Pharm 1997;54:986-7.
  9. Jelliffe RW. Estimation of creatinine clearance when urine cannot be collected. Lancet 1971;1:975-6.
  10. Levey AS, Greene T, Kusek JW, et al. A simplified equation to predict glomerular filtration rate from serum creatinine (Abstr) J Am Soc Nephrol 2000;(11):155A
  11. Levey AS, Greene T, Schluchter MD, et al. Glomerular filtration rate measurements in clinical trials. Modification of Diet in Renal Disease Study Group and the Diabetes Control and Complications Trial Research Group. J Am Soc Nephrol 1993;4(5):1159-71
  12. Levey AS. Assessing the effectiveness of therapy to prevent the progression of renal disease. Am J Kidney Dis 1993;22(1):207-14
  13. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130(6):461-70
  14. Rhodes RS, Sims PJ, Culbertson VL et al. Accuracy of creatinine clearance estimates in geriatric males with elevated serum creatinine clearance. J Geriatric Drug Ther 1991;5:31-45.
  15. Smythe M, Hoffman J, Kizy K et al. Estimating creatinine clearance in elderly patients with low serum creatinine concentrations. Am J Hosp Pharm 1994;51:189-204.
  16. Wilhelm SM, Kale-Pradhan PB. Estimating creatinine clearance: a meta-analysis. Pharmacotherapy 2011; 31: 658-664 [PMID: 21923452 DOI: 10.1592/phco.31.7.658]
  17. Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft-Gault equation. Pharmacotherapy 2012; 32: 604-612 [PMID: 22576791 DOI: 10.1002/j.1875-9114.2012.01098.x]

Disclaimer

All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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