Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Table Graphic Jump Location|Download (.pdf)|Print Child-Pugh Liver Function Classification Assessment Degree of Abnormality Score Encephalopathy grade None 1 or 2 3 or 4 1 2 3 Ascites Absent Slight Moderate 1 2 3 Total bilirubin (mg/dL) <2 2–3 >3 1 2 3 Serum albumin (g/dL) >3.5 2.8–3.5 <2.8 1 2 3 Prothrombin time (seconds prolonged) <4 4–6 >6 1 2 3 Mild hepatic impairment = Child-Pugh class A = Score 5–6 Moderate hepatic impairment = Child-Pugh class B = Score 7–9 Severe hepatic impairment = Child-Pugh class C = Score 10–15 ++ Table Graphic Jump Location|Download (.pdf)|Print Calculation of Creatinine Clearance (CrCl) Timed Urine Collection (Often Used to Approximate Glomerular Filtration Rate [GFR]) Requirements: Timed Urine Collection (Time, Urine Volume, and Creatinine Concentration) and Serum Creatinine Concentration Creatinine clearance (mL/min) = Corrected CrCl (mL/min × 1.73 m2) = Calculation of Creatinine Clearance (CrCl) Cockcroft and Gault Formula Requirements: Weight, Age, and Serum Creatinine Concentration Males CrCl = Females CrCl = Cockcroft and Gault Formula: CrCl in mL/min BW = body weight in kg Age in years SCr in mg/dL Note: estimating ideal body weight in (kg) Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet Note: if the ABW (actual body weight) is less than the IBW, use the ABW for calculating the CrCl Calculation of Estimated Glomerular Filtration Rate (eGFR) Modification of Diet in Renal Disease (MDRD) Formula Requirements: Age, Race, Sex, Serum Creatinine Concentration eGFR = 175 × (SCr)–1.154 × (Age)–0.203 × (0.742 if female) × (1.212 if Black) MDRD formula: eGFR in mL/min/1.73 m² Age in years Standardized SCr in mg/dL ++ Table Graphic Jump Location|Download (.pdf)|Print Guidelines for Chemotherapy Dosage Adjustments Generic Drug Name Hepatic Dysfunction Renal Dysfunction Bilirubin AST/SGOT and/or ALT/SGPT Percent Dosage/Dose Administered Creatinine Clearance (CrCl), Estimated Glomerular Filtration Rate (eGFR), or Serum Creatinine (SCr) Percent Dosage/Dose Administered Abemaciclib1 Child-Pugh class C (severe hepatic impairment) Reduce frequency from twice daily to once daily CrCl ≥30–89 mL/min No dose adjustment necessary CrCl <30 mL/min or requiring hemodialysis No data available; however, no requirement for dose reduction is anticipated because only 3% of a dose is excreted into the urine Abiraterone acetate2 Child-Pugh class B (moderate hepatic impairment prior to starting treatment) Reduce dose to 250 mg once daily No dose adjustment necessary Child-Pugh class C (severe hepatic impairment prior to starting treatment) Has not been studied in this population: avoid Bilirubin >3 × ULN during treatment ALT and/or AST >5 × ULN during treatment Interrupt treatment. Restart 750 mg once daily after LFTs return to baseline or AST and ALT ≤2.5 × ULN and bilirubin <1.5 × ULN Bilirubin >3 × ULN while receiving 750 mg once daily ALT and/or AST >5 × ULN during treatment ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.