Can creatinine clearance be accurately predicted by formulae in octogenarian in-patients?
BACKGROUND
As serum creatinine is relatively inaccurate for estimating renal function, prediction formulae are commonly used for more precise renal function estimation. However, these equations have not been studied in acutely hospitalized octogenarian patients.


OBJECTIVE
To compare three commonly used formulae for estimating GFR to measured creatinine clearance (CCR) in patients aged >/=80 years admitted to an acute geriatric department.


METHODS
Prospective, observational study.


METHODS
Consecutive patients aged >/=80 years with urinary catheters, admitted over a 12-month period to the acute geriatric ward of a 600-bed university hospital, were enrolled in the study. All had an accurate 24-h urinary collection, as well as serum and urinary urea and creatinine determinations. CCR was calculated and compared with GFRs derived from the three formulae.


RESULTS
Of the 154 patients enrolled in the study, 107 (69.5%) had normal serum creatinine (</=1.4 mg/dl), but 77/107 (50.0%) of these had measured CCR </=60 ml/min/1.73 m(2). Mean CCR was 45.1 ml/min/1.73 m(2) declining at the rate of 1.1 ml/min/1.73 m(2) each year. Only 9% of patients according to the Cockcroft and Jelliffe formulae, and 17% by the MDRD formula, fell within -10% and +10% of the measured CCR, which were the limits of agreement decided prior to the initiation of the study.


CONCLUSIONS
Many elderly in-patients with moderate renal dysfunction will remain misidentified by relying on serum creatinine or commonly used prediction equations. The best practical approach in these patients is to avoid potentially nephrotoxic drugs and drugs excreted mainly through the kidneys.
Rimon
E
E
Geriatric Department and Department of Internal Medicine A, Kaplan-Harzfeld Medical Center, and the Hebrew University and Hadassah Medical School, Jerusalem, Israel. efraim_r@clalit.org.il
Kagansky
N
N
Cojocaru
L
L
Gindin
J
J
Schattner
A
A
Levy
S
S
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over / Q000502:physiology*; D000375:Aging / Q000652:urine; D003404:Creatinine / Q000097:blood / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008954:Models, Biological; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000175:diagnosis*; D015203:Reproducibility of Results; D014546:Urinary Catheterization
D003404:Creatinine