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Hospitals | 965 |
Dispensaries | 4,916 |
Basic Health Units | 4,872 |
MCH Centers | 1,138 |
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Human Imported Drugs | 655 |
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Can a Glomerular Filtration Rate Estimate Be Too High? |
QuestionIs a value of 150 or 160 mL/min really accurate when using the Cockcroft and Gault equation to calculate creatinine clearance (CrCl)? An accurate estimate of a patient's glomerular filtration rate (GFR) is a critical element in the safe and effective dosing of renally eliminated medications. Serum creatinine, which is an endogenous marker of glomerular filtration, is commonly used to help estimate the GFR. The GFR estimate is derived using either the Cockcroft-Gaultor modification of diet in renal disease (MDRD) equation.The MDRD equation estimates the GFR directly, whereas the Cockcroft-Gault equation estimates creatinine clearance (CrCl). CrCl is the parameter most often used in clinical trials to determine dose adjustments for renally eliminated medications. Many problems are associated with using estimation equations
Given the aforementioned list, there are reasons that clinicians should be circumspect of extremely elevated estimates:
Due to all the potential factors that affect calculated CrCl or GFR estimates, it is important for the clinician to use judgment when using these values to adjust drug dosages. Rather than blindly following recommendations derived from calculated estimates, careful assessment of the clinical status of the patient and the desired therapeutic outcomes as well as the risks associated with subtherapeutic or supratherapeutic doses of the pharmacologic agent must always be considered. When possible, drug level monitoring will give more accurate guidance to ensure appropriate dosing. |