EVALUATE THE ROUNDING OF SERUM CREATININE IN ELDERLY PATIENTS TO DETERMINE APPROPRIATE DOSING OF RENALLY ADJUSTED MEDICATIONS CARMEN OWENS Dekalb Medical Center - Decatur, GA
Background/Purpose: Creatinine clearance is used to dose many medications. The most accurate method of estimating creatinine clearance is the collection of a 24hr urine creatinine, but this method is not practical. Kidney function has been estimated using the Cockcroft-Gault equation, the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration._x000D_ Creatinine clearance tends to decline with age but without a rise in serum creatinine due to a decrease in muscle mass. There has been debate among clinicians whether it is beneficial to round serum creatinine in older adults. It is believed that rounding serum creatinine to 1 may underestimate the creatinine clearance which could lead to the under-dosing of renally adjusted antibiotics._x000D_ The purpose of this study is to compare Cockcroft-Gault using actual serum creatinine, Cockcroft-Gault using rounded serum creatinine, and MDRD to evaluate how those clearances align with calculated vancomycin clearance. The comparison should assist in determining if it appropriate to round serum creatinine in the elderly population._x000D_
Methodology: The study consisted of a retrospective chart review of patients who are greater than or equal to 60 years old with a serum creatinine less than 1 who were on vancomycin and had a vancomycin level. Charts were reviewed for patient demographics, serum creatinine, vancomycin levels and comorbidities. Vancomycin clearance was compared with Cockcroft-Gault using rounded serum creatinine versus actual serum creatinine. The primary outcome was to determine which method of creatinine clearance estimation correlated best to drug clearance.
Presentation Objective: To compare the current practice of estimating creatinine clearance using rounded serum creatinine versus actual serum creatinine when renally adjusting antibiotics
Self-Assessment: Is rounding the serum creatinine appropriate in the elderly population?
