NEFROCALC 2.0
Bibliography and Formulae

GLOMERULAR FILTRATION RATE
ESTIMATED BY FORMULAE

Cockcroft & Gault

Creatinine clearance (ml/min) = (140-age) x weight/(72 x creatinine)

Women = Creatinine clearance x 0.85
Age: years-old; weight: kg; serum creatinine: mg/dl.

Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.


Unstable renal function

Creatinine clearance (ml/min/1.73m2)=
((293-2.03 x age) x (1.035-0.01685 x (creatinine1+creatinine2)) + 49 x (creatinine1-creatinine2)/days)/(creatinine1+creatinine2)

Women = Creatinine clearance x 0.86

Brater DC. Creatinine clearance from changing serum creatinine, page 2. In: Pocket manual of drug use in clinical medicine, third edition. B.C. Decker Inc., Toronto, 1987.


Sanaka

Creatinine clearance (ml/min/1.73m2):
Men = Actual weight x (19 x serum albumin + 32) / (100 x serum creatinine)
Women = Actual weight x (13 x serum albumin + 29) / (100 x serum creatinine)

Weight: kg. Serum creatinine: mg/dl. Serum albumin: g/dl.

Sanaka M, Takano K, Shimakura K, Koike Y, Mineshita S. Serum albumin for estimating creatinine clearance in the elderly with muscle atrophy. Nephron 1996; 73:137-144.


Schwartz (1)

CLcr (ml/min/1.73m2) = k x height / serum creatinine
k= mathematical constant

Height: cm. Serum creatinine: mg/dl. Preterm newborns (k=0,33). Term newborns and children until 2-years-old (k=0,45). Children over 2-years-old and adolescent girls (k=0,55). Adolescent boys (k=0,70)

Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular filtration rate in full-term infants during the first year of life. J Pediatr 1984 Jun; 104(6):849-54.

Schwartz GJ, Gauthier B. A simple estimate of glomerular filtration rate in adolescent boys. J Pediatr 1985 Mar; 106(3):522-6.


Schwartz (2)

Equation applicable to creatinine standardized by IDMS.
CLcr (ml/min/1.73m2) = 0,41 x height / serum creatinine

Height: cm. Serum creatinine: mg/dl.

Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL. New equations to estimate GFR in children with CKD . J Am Soc Nephrol. 2009 Mar;20(3):629-37.


MDRD abbreviated equation (1)
Creatinine non-IDMS traceable.
GFR (ml/min/1.73m2) = 186 x serum creatinine-1.154 x age-0.203
Women = GFR x 0.742; blacks = GFR x 1.21

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999 Mar 16; 130 (6): 461-70.

Levey AS, Greene T, Kusek JW, Beck GL, MDRD Study Group. A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol 2000 Sep; 11:155A.


MDRD abbreviated equation (2)
Creatinine standardized by IDMS.
GFR (ml/min/1.73m2) = 175 x serum creatinine-1.154 x age-0.203
Women = GFR x 0.742; blacks = GFR x 1.21

Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, Van Lente F; Chronic Kidney Disease Epidemiology Collaboration. Expressing the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate with Standardized Serum Creatinine Values. Clin Chem 2007 Apr;53(4):766-72. Epub 2007 Mar 1.


GFR: CKD-EPI

Women
Race
 Creatinine
 Formula
B ≤ 0.7 GFR = 166*(Cr/0.7)-0.329 * 0.993age
B > 0.7 GFR = 166*(Cr/0.7)-1.209 * 0.993age
W ≤ 0.7 GFR = 144*(Cr/0.7)-0.329 * 0.993age
W > 0.7 GFR = 144*(Cr/0.7)-1.209 * 0.993age
Men
Race
 Creatinine
 Formula
B ≤ 0.9 GFR = 163*(Cr/0.9)-0.411 * 0.993age
B > 0.9 GFR = 163*(Cr/0.9)-1.209 * 0.993age
W ≤ 0.9 GFR = 141*(Cr/0.9)-0.411 * 0.993age
W > 0.9 GFR = 141*(Cr/0.9)-1.209 * 0.993age

B = black
W = white

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med 2009; 150(9):604-12.


GFR: CKD-EPI-Creatinine-Cystatin-C

Women
Race
 Creatinine
 Cystatin
 Formula
B ≤ 0.7 ≤ 0.8 GFR = 130*(Cr/0.7)-0.248 *(Cys/0.8)-0.375 * 0.995age * 1.08
B ≤ 0.7 > 0.8 GFR = 130*(Cr/0.7)-0.248 *(Cys/0.8)-0.711 * 0.995age * 1.08
B > 0.7 ≤ 0.8 GFR = 130*(Cr/0.7)-0.601 *(Cys/0.8)-0.375 * 0.995age * 1.08
B > 0.7 > 0.8 GFR = 130*(Cr/0.7)-0.601 *(Cys/0.8)-0.711 * 0.995age * 1.08
W ≤ 0.7 ≤ 0.8 GFR = 130*(Cr/0.7)-0.248 *(Cys/0.8)-0.375 * 0.995age
W ≤ 0.7 > 0.8 GFR = 130*(Cr/0.7)-0.248 *(Cys/0.8)-0.711 * 0.995age
W > 0.7 ≤ 0.8 GFR = 130*(Cr/0.7)-0.601 *(Cys/0.8)-0.375 * 0.995age
W > 0.7 > 0.8 GFR = 130*(Cr/0.7)-0.601 *(Cys/0.8)-0.711 * 0.995age

Men
Race
 Creatinine
 Cystatin
 Formula
B ≤ 0.9 ≤ 0.8 GFR = 135*(Cr/0.9)-0.207 *(Cys/0.8)-0.375 * 0.995age * 1.08
B ≤ 0.9 > 0.8 GFR = 135*(Cr/0.9)-0.207 *(Cys/0.8)-0.711 * 0.995age * 1.08
B > 0.9 ≤ 0.8 GFR = 135*(Cr/0.9)-0.601 *(Cys/0.8)-0.375 * 0.995age * 1.08
B > 0.9 > 0.8 GFR = 135*(Cr/0.9)-0.601 *(Cys/0.8)-0.711 * 0.995age * 1.08
W ≤ 0.9 ≤ 0.8 GFR = 135*(Cr/0.9)-0.207 *(Cys/0.8)-0.375 * 0.995age
W ≤ 0.9 > 0.8 RFG = 135*(Cr/0.9)-0.207 *(Cys/0.8)-0.711 * 0.995age
W > 0.9 ≤ 0.8 GFR = 135*(Cr/0.9)-0.601 *(Cys/0.8)-0.375 * 0.995age
W > 0.9 > 0.8 GFR = 135*(Cr/0.9)-0.601 *(Cys/0.8)-0.711 * 0.995age

B = black
B = white

Inker AK, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, Kusek JW, Manzi J, Van Lente F, Zhang YL, Coresh J, and Levey AS. Estimating Glomerular Filtration Rate from Serum Creatinine and Cystatin C. N Engl J Med 2012; 367:20-9.


GFR: CKD-EPI-Cystatin-C

Women
Cystatin-C
 Formula
≤ 0.8 GFR = 133*(Cys/0.8)-0.499 * 0.996age * 0.932
> 0.8 GFR = 133*(Cys/0.8)-1.328 * 0.996age * 0.932
Men
Cystatin-C
 Formula
≤ 0.8 GFR = 133*(Cys/0.8)-0.499 * 0.996age
> 0.8 GFR = 133*(Cys/0.8)-1.328 * 0.996age

Inker AK, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, Kusek JW, Manzi J, Van Lente F, Zhang YL, Coresh J, and Levey AS. Estimating Glomerular Filtration Rate from Serum Creatinine and Cystatin C. N Engl J Med 2012; 367:20-9.


Cystatin-C (Larsson)

Glomerular Filtration Rate (ml/min) = 77.24 * Cys[mg/L]-1.2623
Serum Cystatin-C: mg/L.

Larsson A, Malm J, Grubb A, Hansson LO. Calculation of glomerular filtration rate expressed in mL/min from plasma cystatin C values in mg/L. Scand J Clin Lab Invest 2004; 64: 25-30.


GFR: Berlin Initiative Study (BIS)
Equations applicables to creatinine standardized by IDMS.

BIS-Creatinine "BIS-1"
RFG (ml/min/1.73m2) = 3736*Creatinine-0.87*Age-0.95
Serum creatinine: mg/dl.
Age: years-old.
Women: GFR*0.82

BIS-Creatinine-Cystatin-C "BIS-2"

GFR (ml/min/1.73m2) = 767*Cystatin-0.61*Creatinine-0.40*Age-0.57
Serum Cystatin-C: mg/L.
Serum Creatinine: mg/dl.
Age: years-old.
Women: GFR*0.87

Schaeffner ES, Ebert N, Delanaye P, Frei U, Gaedeke J, Jakob O, Kuhlmann MK, Schuchardt M, Tolle M, Ziebig R, van der Giet M, Martus P. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 2012; 157: 471-81.

Lopes MB, Araújo LQ, Passos MT, Nishida SK, Kirsztajn GM, Cendoroglo MS, Sesso R. Estimation of glomerular filtration rate from serum creatinine and cystatin C in octogenarians and nonagenarians. BMC Nephrology 2013; 14: 265.

BIOCHEMICAL AND ANTHROPOMETRIC
USEFUL ESTIMATES

Conversion:
Creatinine non-IDMS to Creatinine IDMS
(vice versa)
IDMS_creat (mg/dL) = Non_IDMS_creat (mg/dL) - 0.067 / 1.065
Non_IDMS_creat(mg/dL) = IDMS_creat (mg/dL) x 1.065 + 0.067
Both applicable to the serum creatinine
in the range of 0.5 to 2.5 mg/dL.

Updated Information for IDMS Traceable. VITROS® Chemistry Products CREA Slides. Ortho-Clinical Diagnostics, Raritan NJ 08869, USA. June 12, 2008.

Standardized (IDMS) Creatinine Testing. Laboratory Technical Bulletin. Lakeland HealthCare, Michigan 49085, USA. December 1, 2008.


Ideal Weight
=for obese=
Ideal weight (kg) = BMI x stature2

BMI: desirable body mass index = 24.9 (upper limit of normal BMI). Stature: in meters.


Chumlea 6 to 80-years-old

Women
Race
 Age (years-old)
 Formulae
B 6-18 (KH*0.71) + (AC*2.59) - 50.43
W 6-18 (KH*0.77) + (AC*2.47) - 50.16
B 19-59 (KH*1.24) + (AC*2.97) - 82.48
W 19-59 (KH*1.01) + (AC*2.81) - 66.04
B 60-80 (KH*1.50) + (AC*2.58) - 84.22
W
 60-80
 (KH*1.09) + (AC*2.68) - 65.51
Men
Race
 Age (years-old)
 Formulae
B 6-18 (KH*0.59) + (AC*2.73) - 48.32
W 6-18 (KH*0.68) + (AC*2.64) - 50.08
B 19-59 (KH*1.09) + (AC*3.14) - 83.72
W 19-59 (KH*1.19) + (AC*3.21) - 86.82
B 60-80 (KH*0.44) + (AC*2.86) - 39.21
W
 60-80
 (KH*1.10) + (AC*3.07) - 75.81

B = blacks
W = whites
KH = knee height (cm)
AC = arm circunference (cm)

Chumlea WC. Ross Knee Height Caliper - Instructions Manual p. 68-69. Ross Laboratories, Columbus, OH, USA, 43210.


Chumlea 60 to 90-years-old

 Men: Weight (kg) = ((0,98 x cc)+(1,16 x kh)+(1,73 x ac)+(0,37 x ssf)-81,69)
Women: Weight (kg) = ((1,27 x cc)+(0,87 x kh)+(0,98 x ac)+(0,4 x ssf)-62,35)

cc = calf circumference [use tape-measure]; kh = knee height [use anthropometer (or tape-measure)]; ac = arm circumference [use tape-measure]; ssf = subscapularis skin fold [use caliper].

Chumlea WC, Roche AF, Steinbaugh ML. Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatric Soc 1985; 33:116-120.


DRUGS DOSING
IN RENAL FAILURE

Formula of Giusti-Hayton-Tozer
=Adults=
AF=1/[fe(FGpat/120-1)+1]

AF = adjustment factor.
fe = The larger fraction of active substances (drugs or metabolites) excreted by the kidneys in normal conditions.
FGpat = Patient's Glomerular filtration rate (ml/min).
120 = Normal Glomerular Filtration Rate (ml/min).

1. Aronoff GR, Bennett WM, Berns JS, Brier ME, Kasbekar N, Mueller BA, et al. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th Ed. Philadelphia (PA): American College of Physicians; 2007.

2. Ashley C, Currie A.: The renal drug handbook. 4th ed. Oxford (UK): Radcliffe Medical Press; 2014.

3. Seyffart G. Seyffart's Directory of Drug Dosage in Kidney Disease. Dustri-Verlag Dr. Karl Feistle GmbH&Co. KG, Munich, 2011.

4. Cervelli MJ. The Renal Drug Reference Guide. Edited by Matthew J Cervelli, Adelaide, Australia; 2008.

5. Barsanulfo-Pereira E. Uso de Medicamentos na Insuficiência Renal. In: Riella MC Princípios de Nefrologia e Distúrbios Hidroeletrolíticos 5ª Ed., Cap. 50;902-938. Editora Guanabara-Koogan, Rio de Janeiro; 2010.

6. Golightly LK, Teitelbaum I, Kiser TH, Levin DA, Barber GR, Jones MA, Stolpman NM, Lundin KS. Renal Pharmacotherapy - Dosage Adjustment of Medications Eliminated by the Kidneys. Springer, NY, 2013.

7. Schrier RW, Gambertoglio JG.: Handbook of Drug Therapy in Liver and Kidney Disease. Little, Brown and Company, Boston, 1991.

8. Barsanulfo-Pereira E. NEFROCALC 1.0 - Calculadora de Filtração Glomerular e Ajuste de Fármacos em Insuficiência Renal. J Bras Nefrol 2008;30/1:6-14.

9. Giusti DL, Hayton WL. Dosage regimen adjustments in renal impairment. Drug Intel Clin Pharm 1973; 7: 382–387.

10. http://www.biam2.org

11. http://www.rxlist.com

12. Mosteller RD. Simplified Calculation of Body Surface Area. N Engl J Med 1987 Oct 22;317(17):1098.

13. Stevens LA, Levey, AS. FAQs: Frequently asked questions about GFR estimates. National Kidney Foundation, New York, 2004. Available from URL: http://www.kidney.org/professionals/kls/pdf/faq_gfr.pdf
(Accessed: September 10, 2007).

14. Thummel KE, Shen DD. Design and optimization of dosage regimens: pharmacokinetic data. In: Hardman JG, Limbird, LE, Gilman AG, editors. Goodman & Gilman’s: The pharmacological basis of therapeutics. 10th ed. New York: McGraw-Hill Medical Publishing Division; 2001. p. 1917-2023.

15. Tozer TN. Nomogram for modification of dosage regimens in patients with renal function impairment. J Pharmacokin Biopharm 1974; 2(1):13-28.


DRUGS REPOSITION POST DIALYSIS

Johnson CA. 2010 Dialysis of Drugs. CKD Insights, LLC. Verona, Wisconsin, USA. Available from URL: http://www.seanmeskill.com/DialysisDrugs2010.pdf
(Accessed: January 09, 2015).

Bailie GR, Mason NA. 2013 Dialysis of Drugs. Renal Pharmacy Consultants, LLC. Saline, Michigan, USA. Available from URL:
http://renalpharmacyconsultants.com/assets/2013dodbooklet.pdf
(Accessed: January 09, 2015).

Bailie GR, Mason NA. 2014 Dialysis of Drugs. Mobile app for iOS, Android and Kindle. Renal Pharmacy Consultants, LLC. Saline, Michigan, USA.


PROGRESSION RISK
OF CHRONIC KIDNEY DISEASE

National Kidney Disease: Improving Global Outomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. Suppl. 2013; 3: 1-150.

Levey AS, de Jong PE, Coresh J, et al. The definition, classification and prognosis of chronic kidney disease, a KDIGO controversies report. Kidney Int. 2011; 80: 17-28.

Stevens PE, Levin, A. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline. Ann Int Med. 2013; 158: 825-30.

Vassalotti JA, and Kaufman HW. Clinical Issues PLUS: New guidelines to evaluate and manage chronic kidney disease. Medical Laboratory Observer. July 2013.
NEFROCALC 2.0 ™

E. Barsanulfo Pereira MD PhD
e-mail: ebarsaper@gmail.com

Retired Professor of Clinical Pharmacology and Nephrology at the Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Brazil. Former Resident Physician (R3) in the Nephrology Department of the Hospital de Clínicas da Universidade Federal do Paraná, Brazil. PhD in Nephrology by the Escola Paulista de Medicina - Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.