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It is an essential requirement to estimate glomerular filtration rate in dosing adjustment of drug treatment for critically ill patients with unstable kidney function. Previous studies showed that Cockcroft-Gault equation was not appropriate for the assessment of unstable kidney function. However, there is a lack of assessment on other equations specifically designed for fluctuating kidney functions. This study is aimed to evaluate the differences between estimated creatinine clearances by using Cockcroft-Gault, Jelliffe, Brater, and Chiou equations and the impact on dosing adjustment of renally excreted drugs for critically ill patients with unstable kidney function. A retrospective observational study was conducted among 103 patients with unstable kidney function who were admitted to intensive care unit of Taiping Hospital, Malaysia. Serum creatinine levels from day 1 to 7 of admission were collected. The median differences of estimated creatinine clearance based on the four different equations were analysed by Friedman-ANOVA test. The median estimated creatinine clearances when patients were having fluctuating kidney functions showed 35.69 ml/min (IQR: 22.57 – 53.97) by Cockcroft-Gault and 22.64 ml/min (IQR: 10.46 – 38.49) by Jelliffe equation, while Brater and Chiou equations showed 35.88 ml/min (IQR: 19.46 – 56.04) and 30.10 ml/min (IQR: 16.55 – 46.82) respectively. Jelliffe and Chiou equation showed a significant 36.56% and 15.66% lower estimated creatinine clearance respectively as compared to Cockcroft-Gault (p < 0.001). Meanwhile, there was no significant difference between Brater and Cockcroft-Gault equation. Jelliffe equation demonstrated the lowest estimated creatinine clearance value with a more intense dosage adjustment required for patients’ drug regimen involving renally excreted drugs. In conclusion, there were clinically significant variations in the estimated creatinine clearance from the different equations.
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