GFR calculation | Forum

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Sep 12 '17
2017-09-12 15:28:22

What estimated GFR calculation do you use? We have our RAD, PHA, and CCIC using different web calculations and we'd like to standardize if possible.
In LAB we use the Cockcroft-Gault eGFR and none of the above departments use it.

Julie Kopp
EHR Analyst
IS Clinicals
Northfield Hospital and Clinics
2000 North Avenue
Northfield, MN 55057
Sep 12 '17
2017-09-12 15:44:46

Hi Julie,
Pharmacy has Lab calculate this automatically so that the system has what we in pharmacy want... It is a bit much... What's CCIC? RAD uses their own ordinary CrCL calculator off the web I think if the patient hasn't had any recent labs that would cause this calculation below to trigger. Pharmacy works off of this result, as well as OE/POM. Of course pharmacy does a more unique calculation when patient variables become critical (amputations, etc.)
Hope it helps!

Andrew Ventura, Pharm.D, MBA
Pharmacy Informaticist, Information Systems
Augusta Health, Fishersville VA
C/S 5.67pp25

;Custom formulas for returning estimated CrCL automatically upon result
; of an SCr. Cockcroft-gault for adults with weight modifications per pharmacy
; Schwarts original for babies less than one year old, and Schwartz revised
; for children 1yo to age 18. Please see Andrew Ventura in Pharmacy/IT with
; any concerns.
; Cockcroft-Gault CrCl = (140-age) * (Wt in kg) * (0.85 if female) / (72 * Cr)
; Per discussion with Clinical Pharmacy Supervisor, patients with no height or no weight should return
; no value at all, so pharmacy does a more thorough review of renal fxn. Same
; for patients < 60" tall.
; Note: Since we are using an IDMS traceable assay for SCR
; we can use this formula for kids 1-18, not the complex one:
; GFR = (0.413 * HTCM)/SCr
; Notes below apply to the code line below each comment.
; ------------------------
;filter out non numeric CRE values.
;store the current age, height, weight, sex to variables,
[f pt cur age]^AGE,
[f pt oe wt kg]^WTKG,
[f pt oe ht cm]^HTCM,
[f pt sex]^SEX,
;Store K value factor for child age and sex.
IF{L(AGE,"D")'=L(AGE) 1^BABY},
IF{BABY=1 0.45}^KVAL,
;Store gender factors for formulas for CrCL and IBW.
IF{SEX="M" "1";"0.85"}^SCC,
IF{SEX="M" "50";"45.5"}^SIBW,
;If 65 or greater and CRET<1.0, assume 1.0, if <65 and CRET<0.8, assume 0.8
IF{(CRET<1.0)&(AGE'<65) "1";(CRET<0.8)&(AGE<65) "0.8";CRET}^CC,
;convert height to inches
;calc IBW
;flag for if pt less than 60" tall
;flag for if pts weight is less than IBW
; check to see if patient is greater than 30% above IBW, if so, use Adj Wt form
IF{((WTKG/IBW)'<1.3) (IBW+(0.4*(WTKG-IBW)))^ADJWT},
;if the patient is not eligible for IBW,use actual,if adjwt exists, use it,
; otherwise use IBW
; If using adjusted weight, make result 4 decimals, otherwise make it 2.
IF{ADJWT_.'=. 1.0000;1.000000}^LIM,
;Do the formula! Hooray!
;if 1-<18 years old, use this formula instead:(revised schwartz)
;do the original schwartz formula for babies < 1 yr old too
;don't result anything if the height or weight is missing or pt <18yo.
;the FV was added by Jeanne in lab, I believe to make it flow through the
;lab analyzers or interfaces.
IF{HTCM_.=. [f lres no prt];WTKG_.=. [f lres no prt];
HTCM<152.4 [f lres no prt];

Sep 12 '17
2017-09-12 22:24:09

We used to use MDRD, but recently switched to CKD Epi at the request of pharmacy. We also calculate Cockcroft-Gault, or will shortly, but it will be internally sent to PHA only & not reported externally.
Thank you,
Alicia Poznanovich
LIS Coordinator
Salinas Valley Memorial Hospital
(831)755-0756 ext 1258