What is the best alternative to inulin clearance to estimate GFR in patients with decompensated alcoholic cirrhosis?
BACKGROUND
Accurate evaluation of the glomerular filtration rate (GFR) in patients awaiting liver transplantation is important because they have a greater risk of impaired renal function. A major percentage of these patients have alcoholic cirrhosis, and the accuracy of bedside used GFR estimates have not been specifically evaluated in this group. The aim of this study was to evaluate the validity of the simplified Modification of Diet in Renal Diseases (MDRD) and Cockcroft and Gault (CG) formulas in patients with decompensated alcoholic cirrhosis in comparison to inulin clearance as the reference method.


METHODS
GFR estimated by the simplified MDRD and CG formulas were retrospectively compared to the true GFR measured by inulin clearance in a single-centre cohort of 148 patients with decompensated alcoholic cirrhosis.


RESULTS
Mean ± standard deviation of age, body mass index, inulin clearance and MDRD and CG estimates were 54.4 ± 6.9 years, 26.5 ± 4.7 kg/m(2), 76.9 ± 28.0 mL/min per 1.73 m(2), 99.4 ± 34.0 mL/min per 1.73 m(2) and 98.7 ± 32.0 mL/min per 1.73 m(2), respectively; 70% of the patients had a GFR, measured by inulin clearance, below 90 mL/min per 1.73 m(2). The difference between estimated GFR and true GFR were 23 ± 23 mL/min per 1.73 m(2) for MDRD and 22 ± 20 mL/min per 1.73 m(2) for Cockcroft and Gault.


CONCLUSIONS
The simplified MDRD and CG formulas largely overestimated GFR in patients with decompensated alcoholic cirrhosis. Results of such bedside formulas should be interpreted with caution in these patients.
Rognant
Nicolas
N
Département de Néphrologie, Hôpital Edouard Herriot, Lyon Cedex 03, France. nicolasrog@hotmail.com
Bacchetta
Justine
J
Dubourg
Laurence
L
Ahmed
Si Nafaa Si
SN
Radenne
Sylvie
S
Dumortier
Jérôme
J
Hadj-Aïssa
Aoumeur
A
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007444:Inulin / Q000493:pharmacokinetics*; D007674:Kidney Diseases / Q000503:physiopathology; D007677:Kidney Function Tests / Q000379:methods; D008104:Liver Cirrhosis, Alcoholic / Q000503:physiopathology*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged
D007444:Inulin; D003404:Creatinine