Cockcroft-Gault revisited: New de-liver-ance on recommendations for use in cirrhosis.
Cockcroft-Gault revisited: New de-liver-ance on recommendations for use in cirrhosis.
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DOI：
10.4254/wjh.v9.i3.131
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发表时间：
2017-01-28
影响因子：
2.4
通讯作者：
Regal RE
中科院分区：
文献类型：
--
作者：
Scappaticci GB;Regal RE
Cockcroft-Gault（CG）方程可能已成为医疗保健专业人员中估计肾功能最流行的实用方法。尽管其被广泛使用，但临床医生往往不仅忽视了原始血清肌酐（SCr）公式的局限性，而且可能不了解用于补偿这些局限性的许多变化的有效性。特别是对于肾病患者，疾病的潜在病理生理学导致SCr假性降低，从而在该人群中使用CG方程高估了肾功能。我们回顾了1976年沿着的原始CG试验，以及随时间推移临床医生对CG方程的特定改变的数据。这些改变包括肥胖患者体重的不同公式和低SCr患者的"四舍五入"方法。此外，我们描述了肝硬化的病理生理学和血流动力学变化，并回顾了几项试图评估这一人群肾功能的研究。我们审查的关于原始CG方程估计肌酐清除率（CrCl）的最准确操作的证据是不确定的。不幸的是，原始CG试验中患者人群的同质性限制了其外部效度。在CG方程中消除体重实际上产生了最接近CrCl测量值的估计值。此外，"四舍五入"的SCr值往往低估了氯化铬。这种方法可能导致低SCr患者的药物治疗剂量不佳。在我们回顾的文献中，在肾病患者中，使用基于SCr的方法高估了真实的肾功能约50%。
The Cockcroft-Gault (CG) equation has become perhaps the most popular practical approach for estimating renal function among health care professionals. Despite its widespread use, clinicians often overlook not only the limitations of the original serum creatinine (SCr) based equation, but also may not appreciate the validity of the many variations used to compensate for these limitations. For cirrhotic patients in particular, the underlying pathophysiology of the disease contributes to a falsely low SCr, thereby overestimating renal function with use of the CG equation in this population. We reviewed the original CG trial from 1976 along with data surrounding clinician specific alterations to the CG equation that followed through time. These alterations included different formulas for body weight in obese patients and the “rounding up” approach in patients with low SCr. Additionally, we described the pathophysiology and hemodynamic changes that occur in cirrhosis; and reviewed several studies that attempted to estimate renal function in this population. The evidence we reviewed regarding the most accurate manipulation of the original CG equation to estimate creatinine clearance (CrCl) was inconclusive. Unfortunately, the homogeneity of the patient population in the original CG trial limited its external validity. Elimination of body weight in the CG equation actually produced the estimate closest to the measure CrCl. Furthermore, “rounding up” of SCr values often underestimated CrCl. This approach could lead to suboptimal dosing of drug therapies in patients with low SCr. In cirrhotic patients, utilization of SCr based methods overestimated true renal function by about 50% in the literature we reviewed.