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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44;</span></p><p class="elsevierStylePara">While we agree with many of the ideas expressed in the letter by Peral et al&#44;<span class="elsevierStyleSup">1</span> we would like to expand on the following&#58;</p><p class="elsevierStylePara">1&#46; Clinical laboratories in Spain&#44; according to national recommendations&#44;<span class="elsevierStyleSup">2</span> generate analytical reports including the glomerular filtration rate &#40;GFR&#41; calculated by means of an equation&#46; Unpublished data from a national survey carried out by the Kidney Function Commission of the Spanish Society of Clinical Biochemistry and Molecular Pathology &#40;CFR-SEQC&#41;&#44; show that out of 281 laboratories surveyed&#44; 88&#37; report GFR&#46; Of these reporting laboratories&#44; 32&#37; calculate GFR using the MDRD-IDMS equation&#44; 62&#37; use the MDRD-4 equation and 4&#37; use the Cockcroft-Gault &#40;CG&#41; or Chronic Kidney Disease Epidemiology Collaboration &#40;CKD-EPI&#41; formulas&#46; Standard procedures for measuring creatinine have become increasingly available in Spain&#44; but it is true that some laboratories that introduced GFR calculated by MDRD-4 &#40;factor 186&#41; in past years have not yet made the necessary leap to the MDRD-IDMS method &#40;factor 175&#41;&#46; The CFR-SEQC is undertaking a series of actions in order to correct this situation&#46;</p><p class="elsevierStylePara">2&#46; We are grateful that the error in the description of the CKD-EPI equation in our article in <span class="elsevierStyleItalic">Nefrolog&#237;a</span><span class="elsevierStyleSup">3</span> was reported&#46; With a view to correcting this and other errors&#44; we sent a list of errata to the journal&#46;</p><p class="elsevierStylePara">3&#46; The recommendations by pharmaceutical companies with regard to adjusting drug doses in patients with compromised renal function follow the Food and Drug Administration &#40;FDA&#41; guidelines and are based on creatinine clearance intervals obtained by using the CG equation&#46;<span class="elsevierStyleSup">4</span> However&#44; neither the methods for measuring creatinine nor the patient samples used to develop the equation are available&#44; meaning that the equation cannot be reformulated for use with creatinine values obtained using current methods&#46; Creatinine clearance values obtained using the CG equation are 10&#37;-20&#37; higher if standard procedures are followed&#44; which overestimates renal function and therefore affects drug dose adjustments&#46;</p><p class="elsevierStylePara">GFR values obtained by using the CG and MDRD methods are not interchangeable&#46; Different studies that compare dosage adjustments based on the CG and MDRD methods report differences in between 10&#37; and 40&#37; of cases&#46;<span class="elsevierStyleSup">5</span> Comparing these studies is difficult due to the variability of the creatinine measurement methods used when calculating the equations and the type of patients studied&#46; In addition&#44; their interpretation is complex&#44; since they do not assess the clinical consequences of discrepancies between doses that result from using one equation or another&#46; Only one study compares concordance between the assignment to an FDA-listed category&#44; based on GFR measurement &#40;iothalamate clearance&#41;&#44; and 3 equations &#40;MDRD-IDMS&#44; CG using real weight&#44; and CG using the ideal weight value&#41;&#44; in addition to differences in recommended doses between the 3 equations with respect to 15 drugs that are excreted renally&#46;<span class="elsevierStyleSup">6</span> Results from the comparison show that concordance with the recommended doses of the 15 drugs&#44; based on the GFR measurement&#44; was greater for MDRD-IDMS &#40;88&#37;&#41; than for CG with ideal weight &#40;82&#37;&#41; or CG with real weight &#40;85&#37;&#41;&#46; Concordance between recommended doses was 89&#37; between MDRD-IDMS and CG with ideal weight&#46;</p><p class="elsevierStylePara">The American College of Clinical Pharmacy Nephrology Practice and Research Network recommends that neither CG nor MDRD be used as the only measurement to determine dosage-adjustment decisions&#46; Other factors should also be considered&#44; such as the way equations work in specific population groups&#44; the therapeutic index&#44; drug indication and toxicity profile&#44; availability of other treatment agents&#44; the possibility of monitoring drug concentrations in blood and more precise means of measuring creatinine clearance or glomerular filtration rate&#46;<span class="elsevierStyleSup">5</span> The National Kidney Foundation Education Program recommends that both CG and MDRD-IDMS be used when estimating renal function in order to adjust drug doses&#46;<span class="elsevierStyleSup">7</span> Likewise&#44; the FDA recently proposed that MDRD-IDMS be used along with CG in future pharmacokinetic studies in patients with kidney disease&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">We believe that the value of GFR calculated based on the MDRD-IDMS equation is a valid tool for assessing renal function for purposes of adjusting drug doses for several reasons&#58; 1&#41; it is based on creatinine measurement procedures that have been standardised against the reference method&#59; 2&#41; it correlates better with measured GFR than the CG method for GFR values &#60;60ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; which are the most susceptible to dosage adjustments&#59; and 3&#41; it is available in most clinical laboratory reports&#44; unlike CG&#46;</p><p class="elsevierStylePara">We agree with Peral et al that while the GFR value obtained by MDRD-IDMS is expressed in ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; absolute values &#40;ml&#47;min&#41; should be used for this purpose in patients whose body surface area varies considerably from the standard area of 1&#46;73m<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p>"
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