Implications of serum creatinine measurements on GFR estimation and vancomycin dosing in children

Gal Neuman, Irena Nulman, Khosrow Adeli, Gideon Koren, David A. Colantonio, Anders Helldén

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background Different serum creatinine (sCr) assays may obtain different values in the same patient, causing discrepancies in estimated glomerular filtration rate (eGFR) and sCr-based vancomycin dosing calculations. Objective To identify potential discrepancies in sCr concentrations obtained by different assays, the compensated Jaffe (sCr-Jaffe) and the enzymatic (sCr-enz), and to compare between the eGFR and vancomycin daily dose, based on these sCr values. Method sCr-Jaffe and, sCr-enz concentrations of 890 healthy children, aged 1-18 years, were available from the Canadian Laboratory Initiative in Pediatric Reference Intervals study in Ontario. For each subject, eGFR (eGFR-Jaffe, eGFR-enz) was calculated using the revised Schwartz equation, and vancomycin daily dose (Vdose-Jaffe, Vdose-enz) was calculated using a sCr-based pharmacokinetic model. Result Significant, age-related differences were found in sCr concentrations, and in subsequent eGFR and Vdose, between the two assays. In children aged 1-5 years, mean sCr-Jaffe was higher than sCr-enz (44.0±5.0 vs. 27.7±7.3μmol/L, P<0.001), leading to lower eGFR-Jaffe (83.2±9.0 vs. 137.9±27.1mL/min/1.73m2, P<0.001) and lower Vdose-Jaffe (44.7±2.5 vs. 53.5±5.1mg/kg/24h, P<0.001). Conclusion Based on these findings, young children may be at risk for vancomycin under-treatment. Further research is needed to define the more accurate sCr assay in young children treated with renally excreted drugs.

Original languageEnglish
Pages (from-to)785-791
Number of pages7
JournalJournal of Clinical Pharmacology
Issue number7
StatePublished - Jul 2014
Externally publishedYes


  • dosing guidelines
  • laboratory medicine
  • pharmacokinetics
  • renal drug clearance


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