Estimation of creatinine clearance in end-stage liver disease

David E. Nix, Brian L. Erstad, Paul Z. Nakazato, Jeffrey F. Barletta, Kathryn R. Matthias, Todd S. Krueger

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


BACKGROUND: Estimation of renal function in patients with end-stage liver disease (ESLD) is complicated by several factors. OBJECTIVE: To develop a practical and relatively inexpensive method for estimating creatinine production and clearance in patients with ESLD. METHODS: Serum creatinine concentrations and urinary excretion of creatinine were measured in 27 patients with moderate-to-severe liver disease with the goal of developing equations to predict creatinine clearance from serum creatinine. Subjects were studied during an initial evaluation for a liver transplant program. Two 24 hour urine specimens were collected along with 3 serum samples over a 2 day evaluation period. Serum and urine creatinine concentrations were determined using both a modified Jaff́ (autoanalyzer) method and an HPLC method. The data were analyzed using nonlinear mixed-effects modeling. RESULTS: Considering both statistical criteria and physiological conventions through allometric scaling theory, creatinine clearance (mL/min) in males can be estimated as (80/serum creatinine) × (actual body weight/70)0.75. For females, the same equation is valid, but the result is multiplied by 0.661. A simplified equation without the exponent is presented, along with equations that are appropriate when an HPLC assay is used for greater specificity. CONCLUSIONS: These equations offer potential for improved estimation of creatinine clearance in patients with liver impairment; however, they need further validation using an independent group of subjects.

Original languageEnglish (US)
Pages (from-to)900-908
Number of pages9
JournalAnnals of Pharmacotherapy
Issue number5
StatePublished - May 2006


  • Assay
  • Creatinine clearance
  • Liver disease
  • Renal function

ASJC Scopus subject areas

  • Pharmacology (medical)


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