Accuracy of freely available online GFR calculators using the CKD-EPI equation
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Accuracy of freely available online GFR calculators using the CKD-EPI equation Sarah Seiberth 1,2 & Theresa Terstegen 3 & Dorothea Strobach 1,2 & David Czock 3 Received: 9 March 2020 / Accepted: 9 June 2020 # The Author(s) 2020
Abstract Purpose Estimated glomerular filtration rate (eGFR) as calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is used for detection of chronic kidney disease and drug dose adjustment. The purpose of the present study was to investigate the accuracy of freely available eGFR online calculators. Methods All identified CKD-EPI online calculators were run with five reference cases differing in age, sex, serum creatinine, and ethnicity. Conversion from eGFRindexed (unit ml/min per 1.73 m2) to eGFRnon-indexed (unit ml/min) and creatinine unit from milligramme/decilitre to micromole/litre was checked, if available. Results Only 36 of 47 calculators (76.6%) produced accurate eGFR results for all reference cases. Eight of 47 (17.0%) calculators were considered as faulty because of errors relating to ethnicity (4 calculators), to conversion of the eGFR unit (2 calculators), to erroneous eGFR values without obvious explanation (2 calculators), to conversion of the creatinine unit (1 calculator), and to an error in the eGFR unit displayed (1 calculator). Overall, 28 errors were found (range 59 to 147% of the correct eGFR value), the majority concerning calculation of eGFRindexed and the conversion to eGFRnon-indexed. Only 7 of 47 (14.9%) calculators offered conversion of the eGFR unit. Conclusions Erroneous calculations that might lead to inappropriate clinical decision-making were found in 8 of 47 calculators. Thus, online calculators should be evaluated more thoroughly after implementation. Conversion of eGFR units that might be needed for drug dose adjustments should be implemented more often. Keywords Estimated glomerular filtration rate . CKD-EPI equation . Online calculator . Drug dose adjustment
Introduction In clinical routine, glomerular filtration rate (GFR) is most commonly estimated with the creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-020-02932-x) contains supplementary material, which is available to authorized users. * David Czock [email protected] 1
Hospital Pharmacy, University Hospital, LMU Munich, Munich, Germany
2
Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Munich, Germany
3
Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
equation, which is used for detection and staging of chronic kidney disease (CKD) [1, 2]. Drug dose adjustments in patients with renal impairment are traditionally based on creatinine clearance, using either the endogenous creatinine clearance or, more easily, Cockcroft and Gault’s equation [3, 4]. In this regard, creati
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