From the Research
I strongly recommend using the REFIT equation for estimating glomerular filtration rate (GFR) in patients, as it has been shown to have the least absolute median bias compared to the CKD-EPI and EKFC formulas, particularly in Black and White individuals 1.
Key Considerations
- The REFIT equation is a more accurate estimator of GFR, especially in patients with eGFR < 80 mL/min per 1.73 m2 in Black individuals and eGFR > 20 mL/min per 1.73 m2 in White individuals.
- The EKFC equation, although accurate, may underestimate the measured GFR (mGFR) at lower eGFR levels, which could impact CKD classification and clinical management.
- The choice of eGFR formula may have significant implications for clinical decision-making, particularly in patients with kidney disease or those at risk of developing kidney disease.
Clinical Implications
- Clinicians should consider using the REFIT equation for estimating GFR in their patients, especially those with kidney disease or at risk of developing kidney disease.
- Close monitoring of kidney function and adjustment of medications or treatments as needed is crucial in patients with kidney disease.
- Further studies are needed to validate the use of the REFIT equation in diverse populations and to determine its impact on clinical outcomes.
Treatment Approach
- The treatment approach for patients with EGFR-mediated cutaneous reactions (CR) of grade 6 severity should prioritize reducing inflammation and preventing further skin toxicity.
- While epinephrine 1:1000 concentration at a dose of 6 mg/kg may be considered for treatment, its use should be carefully weighed against potential cardiovascular side effects.
- Transition to oral antihistamines and topical corticosteroids for maintenance therapy may be necessary to manage ongoing skin reactions.
- Patient education on potential skin toxicity and close monitoring for cardiovascular side effects are essential components of treatment.