The performance of contemporary cystatin C-based GFR equations in predicting gentamicin clearance

Abstract

Aims We aimed to compare the performances of contemporary cystatin C (Cys)-based GFR equations, and the creatinine only Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for predicting gentamicin clearance. Methods The bias and imprecision of the CKD-EPI, CKD-EPI-Cys and creatinine-cystatin C CKD-EPI (CKD-EPI-CrCys) equations for predicting gentamicin clearances, were assessed in 260 patients treated with gentamicin during 2012-2013. The creatinine-cystatin C Berlin Initiative Study equation (BIS-CrCys) was examined in the ≥70 year subgroup. The reference gentamicin clearance was calculated using post-dose plasma concentrations. Results The CKD-EPI-CrCys equation had the highest percentage of estimates within 30% of the reference gentamicin clearance (70%, P = 0.003) and lowest root mean square error (95% CI) of 29 (25, 23) ml min-1 of the three equations for the entire cohort. There was no significant improvement in the performances of the equations with the exclusion of 41 patients with abnormal thyroid function tests or steroid co-prescription at the time of the index gentamicin dose. Of the remaining 219 patients, adjustment for individual BSA improved the performances of all GFR equations (P ≤ 0.003) in those with body mass indices (BMI) <18.5 or ≥30 kg m-2, but not those with BMI 18.5-29.9 kg m-2. There was no advantage of the BIS-CrCys over the CKD-EPI-CrCys equation in the ≥70 year subgroup. Conclusions The CKD-EPI-CrCys equation provided the best estimate of gentamicin clearance. If used for guiding gentamicin dosing, the results from GFR equations should be adjusted for individual BSA at the extremes of body size.