Under-recognized renal insufficiency in hospitalized patients: implications for care.
BACKGROUND
The consequences of undetected low glomerular filtration rate (GFR) are important in hospitalized patients who receive potentially nephrotoxic drugs or undergo major surgery. This study estimated the prevalence of estimated GFR (eGFR) <60mL/min/1.73m(2) in hospitalized patients.


METHODS
This cross-sectional descriptive study included 14,658 adults hospitalized at 10 centers in Spain. Serum samples were analyzed for hemoglobin, creatinine, albumin and urea nitrogen. eGFR was estimated using Modification of Diet in Renal Disease (MDRD) 4 or MDRD IDMS, and MDRD 6 when serum albumin and BUN were included (n=8611). Individuals were classified as having GFR>or=60mL/min/1.73m(2), stages 3, 4 and 5 (GFR 30-59, 15-29 and <15mL/min/1.73m(2), respectively). Additionally, stages 3a and 3b (GFR 45-59 and 30-44mL/min/1.73m(2), respectively) were assessed.


RESULTS
MDRD 4 eGFR showed that 28.3% of patients had renal insufficiency stages 3-5 and 14.2% had stages 3b, 4 or 5, which represents important-severe renal deterioration. Forty-three percent of patients with stages 3-5 had hemoglobin <or=11g/dL, compared with 27.9% of patients with eGFR>or=60mL/min/1.73m(2). A good correlation was observed between eGFR MDRD 4 and MDRD 6.


CONCLUSIONS
A high percentage of hospitalized patients in Spain have deteriorated renal function stages 3-5. Using eGFR equations to assess eGFR could identify more hospitalized patients with renal insufficiency, potentially leading to improved care.
de Francisco
A L M
AL
Servicio de Nefrología, Hospital Universitario Valdecilla, Santander, Spain. angel.martin@unican.es
Fernandez
E
E
Cruz
J J
JJ
Casas
M T
MT
Gómez-Gerique
J
J
León
A
A
Cava
F
F
Bedini
J L
JL
Enguix
A
A
Ripoll
E
E
Borque
L A
LA
Fernandez
A
A
Arias
M
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000453:epidemiology; D012720:Severity of Illness Index; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D055815:Young Adult
D006454:Hemoglobins