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- COCKCROFT-GAULT CREATININE CLEARANCE EQUATION TEMPLATE


PAGE CONTENTS

 * How it works
 * Cockcroft-Gault calculation
 * Related content
 *  




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COCKCROFT-GAULT CREATININE CLEARANCE EQUATION TEMPLATE

Article metadata. Revised by Paul Mercer

This article was updated • 4mo ago4 months ago
This article has 2507 views. • 2507 Views

--------------------------------------------------------------------------------

The 'Estimated Creatinine Clearance (Cockcroft Gault)’ is available all
organisations. The template has been released active and provides the means to
perform the Cockcroft-Gault Creatinine Clearance estimation calculation.

The template should only be used by clinicians, with a thorough understanding of
how to interpret the text shown in the template. The clinician must apply
appropriate clinical judgement when making prescribing adjustments. The decision
needs to be made on an individual, patient specific basis.

You'll find the template in EMIS Library > Primary care templates > History and
Exam.

The library item within the template has recently been updated and now looks for
missing care record data and highlights this in red text at the top of the
template.  


As part of this enhancement the following library items have been archived and
will no longer be supported:

 * Cockcroft Gault calculation
 * Estimated Creatinine Clearance (Cockcroft Gault)



Estimated Creatinine Clearance (Cockcroft Gault) template.


HOW IT WORKS

To save time in a consultation, you can simply launch the template from the
ribbon. Review the required patient data and record up to date values only if
necessary to perform the calculations, and then save the template.

The calculation will always use the latest values of each entry. If the latest
entries displayed on the right-hand side of the template are correct, you do not
need to re-enter these values before clicking calculate.

When you save the consultation, all the information entered via the template is
saved in the patient record using a standardised set of clinical terms.


COCKCROFT-GAULT CALCULATION

There's an ongoing debate, between healthcare specialists, concerning which
weight is correct to use in the Cockcroft-Gault calculation (actual body weight
or ideal body weight).

The original study, published in 1976, used actual body weight, but it mentioned
that a correction factor was likely needed for those who are obese.

We've reviewed various formulae, and the formula used in EMIS Web is displayed
on our Estimated Creatinine clearance (Cock-croft Gault) template as follows:



This version of the formula underestimates the Creatinine Clearance in obese
patients, this is safer when it comes to renal damage. However, when DOAC's
(Direct Oral Anticoagulants) are being dose adjusted, the risk of
under-coagulation is more serious than the risk of renal impairment. Clinical
judgement needs to be taken into account in these cases. 

April 2019 update: There has been debate in the literature over which
calculation to use when dose adjusting DOAC’s (Direct Oral Anticoagulants). We
have sought clarification from the manufacturers. To align with the
manufacturer’s letters of clarification, and evidence base from their clinical
trials, patients with an active prescription for Apixaban, Edoxaban and
Rivaroxaban or an issue of the above within the last 3 months will have
estimated creatinine clearance calculated using actual body weight. The
manufacturer of Dabigatran advises use of ideal or adjusted body weight in
overweight or obese patients. EMIS Web uses ideal body weight for patient’s on
Dabigatran.

We've added text information to advise whether ideal or actual body weight has
been used each time the calculation is made. If ideal body weight has been used,
the template will also display the result of the calculation if actual body
weight had been taken into account instead:


Text shown when ideal body weight is used to calculate estimated creatinine
clearance.

 


Text shown when actual body weight is used to calculate estimated creatinine
clearance.

 


Text shown when DOAC prescribing is present and actual body weight is used to
calculate estimated creatinine clearance to align with manufacturers guidance
and trial evidence.

 


RELATED CONTENT

This article highlights the difficulties in finding the best way to measure
creatinine clearance at the extremes of weight.


 

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