Background: The choice of renal function estimation equations may influence the diagnosis of chronic kidney disease (CKD) and dosing of renally cleared drugs, such as antibiotics. While certain equations (Cockcroft-Gault [CG], Modification of Diet in Renal Disease [MDRD], and Chronic Kidney Disease Epidemiology Collaboration [CKDEPI]) are commonly used in clinic, a new CKDEPI equation (CKDEPI-new) has been developed that omits race. This study aims to investigate the potential benefit of CKDEPI-new on CKD staging and simulated antibiotic exposure in a virtual population, with particular regard to race. Methods: A total of 8121 subjects from the NHANES database were included in the study. CKD staging was calculated for each subject based on each equation listed. Based on the estimated renal functions, the dosing of amikacin, levofloxacin, and cefepime were assigned and compared. Pharmacokinetic profiles of each antibiotic were simulated, and probability of target attainment (PTA) and cumulative fraction of response (CFR) were calculated to examine the impact of equation choice on the drug efficacy. Results: Compared with the CKD staging by CKDEPI in all subjects, CKDEPI-new had the highest agreement at 90%. However, agreement within the black population was lower for CKDEPI-new (85%) than MDRD (93%). CKDEPI-new showed similar agreement rate in dosing of antibiotics by CG with other equations. The impact of equations on drug efficacy evaluated by PTA and CFR in different race groups were small, with relative difference of less than 1%. Conclusion: CKDEPI-new is potentially suitable to be interchangeably used with CKDEPI in CKD staging but may lead to higher CKD staging in black population. There is the possibility of interchangeable use of the renal estimation equations in dosing of antibiotics to achieve similar efficacies.
