This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Melloni, C. Articles by Alexander, K. P. Search for Related Content PubMed PubMed Citation Articles by Melloni, C. Articles by Alexander, K. P.

CLINICAL RESEARCH: RENAL FUNCTION IN ACUTE CORONARY SYNDROME

Cockcroft-Gault Versus Modification of Diet in Renal Disease

Importance of Glomerular Filtration Rate Formula for Classification of Chronic Kidney Disease in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

Chiara Melloni, MD, MHS^_*, Eric D. Peterson, MD, MPH^_*, Anita Y. Chen, MS^_*, Lynda A. Szczech, MD, MSCE^_*, L. Kristin Newby, MD, MHS^_*, Robert A. Harrington, MD^_*, W. Brian Gibler, MD, E. Magnus Ohman, MD^_*, Sarah A. Spinler, PharmD, FCCP, Matthew T. Roe, MD, MHS^_* and Karen P. Alexander, MD^_*,_*

^_* Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania.

Manuscript received May 29, 2007; revised manuscript received October 5, 2007, accepted November 8, 2007.

^_* Reprint requests and correspondence: Dr. Karen P. Alexander, 2400 Pratt Street, Duke Clinical Research Institute, Durham, North Carolina 27705. (Email: alexa019{at}mc.duke.edu).

Objectives: Our purpose was to compare formulae for estimating glomerular filtration rate (GFR) in non–ST-segment elevation acute coronary syndromes (NSTE ACS) patients.

Background: Assessment of GFR is important for antithrombotic dose adjustment in NSTE ACS patients.

Methods: We assessed estimated glomerular filtration rate (eGFR) with Cockcroft-Gault (C-G) and Modification of Diet in Renal Disease (MDRD) formulae in 46,942 NSTE ACS patients from 408 CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines) hospitals. Formula agreement was shown continuously and by chronic kidney disease (CKD) stages. We determined in-hospital outcomes and the association between antithrombotic dose adjustment and bleeding for moderate CKD as determined by each formula.

Results: The median (interquartile range [IQR]) eGFR was 53.2 ml/min (34.7, 75.1 ml/min) by C-G and 65.8 ml/min (47.6, 83.5 ml/min) by MDRD. The mean eGFR was higher with MDRD (9.1 ml/min), but this difference was greater in age, weight, and gender subgroups. Chronic kidney disease classification differed in 20% of the population and altered when antithrombotic dose adjustment was required by C-G versus MDRD (eptifibatide: 45.7% vs. 27.3%; enoxaparin: 19.0% vs. 9.6%).

Conclusions: Important CKD disagreements occur in 20% of acute coronary syndrome patients, affecting dosing adjustments in those already susceptible to bleeding. Dosing based on C-G formula is preferable, particularly in the small, female, or elderly patient.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   BMI = body mass index   CI = confidence interval   CKD = chronic kidney disease   C-G = Cockcroft-Gault   eGFR = estimated glomerular filtration rate   GFR = glomerular filtration rate   GP = glycoprotein   MDRD = Modification of Diet in Renal Disease   NSTE ACS = non–ST-segment elevation acute coronary syndromes   OR = odds ratio

This article has been cited by other articles:

				H. F. AlFaleh, A. O. Alsuwaida, A. Ullah, A. Hersi, K. F. AlHabib, A. AlShahrani, K. AlNemer, S. AlSaif, A. Taraben, W. H. Ahmed, et al. Glomerular Filtration Rate Estimated by the CKD-EPI Formula is a Powerful Predictor of In-Hospital Adverse Clinical Outcomes After an Acute Coronary Syndrome Angiology, February 1, 2012; 63(2): 119 - 126. [Abstract] [PDF]

				A. Akerblom, L. Wallentin, A. Siegbahn, R. C. Becker, A. Budaj, K. Buck, E. Giannitsis, J. Horrow, S. Husted, H. A. Katus, et al. Cystatin C and Estimated Glomerular Filtration Rate as Predictors for Adverse Outcome in Patients with ST-Elevation and Non-ST-Elevation Acute Coronary Syndromes: Results from the Platelet Inhibition and Patient Outcomes Study Clin. Chem., January 1, 2012; 58(1): 190 - 199. [Abstract] [Full Text] [PDF]

				L. A. Taylor and V. F. Mauro Incidence of Bleeding in Renally Impaired Patients Receiving Incorrectly Dosed Eptifibatide or Bivalirudin While Undergoing Percutaneous Coronary Intervention Ann. Pharmacother., January 1, 2012; 46(1): 35 - 41. [Abstract] [Full Text] [PDF]

				L. Zhang, N. Xu, S. Xiao, V. Arya, P. Zhao, L. J. Lesko, and S.-M. Huang Regulatory Perspectives on Designing Pharmacokinetic Studies and Optimizing Labeling Recommendations for Patients With Chronic Kidney Disease J. Clin. Pharmacol., January 1, 2012; 52(1_suppl): 79S - 90S. [Abstract] [Full Text] [PDF]

				A. Corsonello, C. Pedone, F. Lattanzio, R. Semeraro, F. D'Andria, M. Gigante, A. Coppola, G. Cadeddu, I. Laino, and R. Antonelli Incalzi Agreement between equations estimating glomerular filtration rate in elderly nursing home residents and in hospitalised patients: implications for drug dosing Age Ageing, September 1, 2011; 40(5): 583 - 589. [Abstract] [Full Text] [PDF]

				J. B. Wetmore, R. A. Honea, E. D. Vidoni, A. Almehmi, and J. M. Burns Role of lean body mass in estimating glomerular filtration rate in Alzheimer disease Nephrol. Dial. Transplant., July 1, 2011; 26(7): 2222 - 2231. [Abstract] [Full Text] [PDF]

				T. H. Denetclaw, N. Oshima, and T. C. Dowling Dofetilide Dose Calculation Errors in Elderly Associated with Use of the Modification of Diet in Renal Disease Equation Ann. Pharmacother., July 1, 2011; 45(7-8): e44 - e44. [Abstract] [Full Text] [PDF]

				M. A. Jones, L. K. Golightly, and N. M. Stolpman Use of Recalibrated Serum Creatinine Concentrations for Adjustment of Drug Dosages: Determination of Values Compatible with Conventional Dosing Recommendations Ann. Pharmacother., June 1, 2011; 45(6): 748 - 756. [Abstract] [Full Text] [PDF]

				S. James, A. Budaj, P. Aylward, K. K. Buck, C. P. Cannon, J. H. Cornel, R. A. Harrington, J. Horrow, H. Katus, M. Keltai, et al. Ticagrelor Versus Clopidogrel in Acute Coronary Syndromes in Relation to Renal Function: Results From the Platelet Inhibition and Patient Outcomes (PLATO) Trial Circulation, September 14, 2010; 122(11): 1056 - 1067. [Abstract] [Full Text] [PDF]

				A. D. Michaels, S. A. Spinler, B. Leeper, E. M. Ohman, K. P. Alexander, L. K. Newby, H. Ay, W. B. Gibler, on behalf of the American Heart Association Acute, Council on Cardiopulmonary, Critical Care, Periope, et al. Medication Errors in Acute Cardiovascular and Stroke Patients: A Scientific Statement From the American Heart Association Circulation, April 13, 2010; 121(14): 1664 - 1682. [Full Text] [PDF]

				C. S. Fox, P. Muntner, A. Y. Chen, K. P. Alexander, M. T. Roe, C. P. Cannon, J. F. Saucedo, M. C. Kontos, and S. D. Wiviott Use of Evidence-Based Therapies in Short-Term Outcomes of ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Myocardial Infarction in Patients With Chronic Kidney Disease: A Report From the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network Registry Circulation, January 26, 2010; 121(3): 357 - 365. [Abstract] [Full Text] [PDF]

				H. Cardinal, P. Bogaty, F. Madore, L. Boyer, L. Joseph, and J. M. Brophy Therapeutic Management in Patients with Renal Failure who Experience an Acute Coronary Syndrome Clin. J. Am. Soc. Nephrol., January 1, 2010; 5(1): 87 - 94. [Abstract] [Full Text] [PDF]

				A. Cohen-Solal, D. Kotecha, D. J van Veldhuisen, D. Babalis, M. Bohm, A. J. Coats, M. Roughton, P. Poole-Wilson, L. Tavazzi, M. Flather, et al. Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial Eur J Heart Fail, September 1, 2009; 11(9): 872 - 880. [Abstract] [Full Text] [PDF]

				S. A Chapman, A. J Kaufenberg, P. Anderson, A. Khokhar, and C. G Schrock Safety and Effectiveness of a Modification of Diet in Renal Disease Equation-Based Potassium Replacement Protocol Ann. Pharmacother., March 1, 2009; 43(3): 436 - 443. [Abstract] [Full Text] [PDF]

				R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1095 - 1103. [Full Text] [PDF]