Interest and limits of glomerular filtration rate (GFR) estimation with formulae using creatinine or cystatin C in the malnourished elderly population.
Renal function is often altered in elderly patients. A lot of formulae are proposed to estimate GFR to adjust drug posology. French guidelines recommend the Cockcroft-Gault formula corrected with the body surface area (cCG), but the initially described unadjusted Cockcroft-Gault equation (CG) is mainly used in geriatric clinical practice. International recommendations have proposed the modification of diet in renal disease (MDRD) formula, since several authors recommended the Rule formula using cystatin C (cystC) in particular population. To appreciate the most accurate GFR estimation for posology adaptation in an elderly polypathological population, a cross-sectional study with prospective inclusion was carried out in Charles Foix Hospital. Plasma glucose levels (PGL), creatinine (CREA) levels and serum cystC, albumin (ALB), transthyretin (TTR), C-reactive protein (CRP), orosomucoid (ORO) total cholesterol (tCHOL) levels were determined among 193 elderly patients aged 70 and older. The results showed that in a malnourished, inflamed old population, CG, MDRD and Rule formulae resulted in different estimations of GFR, depending on nutritional and inflammatory parameters. Only cCG estimation was shown to be independent from these parameters. To conclude, cCG seems to be the most accurate and appropriate formula in a polypathological elderly population to evaluate renal function in order to adapt drug posology.
Fabre
Emmanuelle E
EE
Biochemistry Department, APHP, Avicenne Hospital, EA 3406 Paris XIII University, 74 rue M. Cachin, 93000 Bobigny cedex, France.
Raynaud-Simon
Agathe
A
Golmard
Jean-Louis
JL
Gourgouillon
Nadège
N
Beaudeux
Jean-Louis
JL
Nivet-Antoine
Valérie
V
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood; D005260:Female; D005602:France; D015577:Geriatric Assessment / Q000379:methods*; D005919:Glomerular Filtration Rate; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications*; D019338:Polypharmacy; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results
D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine