Role of creatinine clearance as a screening test in persons with spinal cord injury.
OBJECTIVE
To determine (1) the variability of annual creatinine clearance (C(Cr)) testing for subjects with chronic spinal cord injury (SCI) and (2) whether decisions to change neurogenic bladder management are made based on C(Cr) measurements.


METHODS
Retrospective chart review.


METHODS
Inpatient Veterans Affairs SCI unit.


METHODS
The medical records of 70 men were consecutively selected for review from among 664 veterans enrolled in the SCI clinic. All patient charts had to have at least 5 C(Cr) tests performed within 10 years preceding the review.


METHODS
Not applicable.


METHODS
Development of renal insufficiency and change in medical or bladder management of the patient, based on the results of the C(Cr) test.


RESULTS
For individual patients, the results of 24-hour C(Cr) were highly variable from 1 evaluation to the next; the within-subject standard deviation (SD) for C(Cr) was 25.9mL/min. The within-subject SD for serum creatinine was 0.12mg/dL. For all comparisons of repeatability, variability, and reliability, serum creatinine was superior to C(Cr). No medical management decisions were made based on the result of the 24-hour creatinine clearance. Renal ultrasound results and postvoid bladder residuals were the major factors in changing medical management with regard to renal function preservation.


CONCLUSIONS
The C(Cr) test has little value as a screening measure for renal disease in SCI patients because of its variability in serial testing.
Spinal Cord Injury Unit, VA-Puget Sound Health Care System, Seattle, WA 98108, USA.
Farhad
F
Sepahpanah
Stephen P
SP
Burns
Barbara
B
McKnight
Claire C
CC
Yang
D015415:Biomarkers / Q000378:metabolism; D003404:Creatinine / Q000652:urine*; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology*; D014463:Ultrasonography; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology
D015415:Biomarkers; D003404:Creatinine