title: Chronic kidney disease staging in nursing home and community older adults: does the choice of cockcroft-gault, modification of diet in renal disease study, or the chronic kidney disease epidemiology collaboration initiative equations matter?
abstract: OBJECTIVE
  To compare the chronic kidney disease (CKD) stages derived from GFR estimates using 3 different formulae in a sample of older adults from the community and long term care settings.
  
  
  METHODS
  Data from 1535 older, hospitalized patients (2000-2008) were collected; individuals were hospitalized for acute illness unrelated to renal function.
  
  
  METHODS
  Patient demographics, pertinent medical history, and routine laboratory test results were collected. Estimate of glomerular filtration rate and creatinine clearance values were determined by the Cockcroft-Gault, Modification of Diet in Renal Disease Study, and Chronic Kidney Disease Epidemiology Collaboration equations.
  
  
  RESULTS
  The Cockcroft-Gault equation generated significantly lower mean estimate of glomerular filtration rate values than either Modification of Diet in Renal Disease Study or Chronic Kidney Disease Epidemiology Collaboration equations in the total sample (P < .0005) and in a subset of patients diagnosed as renal insufficiency (P < .00005). Using the 3 formulae produced a significant disconnect in CKD staging resulting in the potential for different recommendations for monitoring and management across formulae (National Kidney Foundation Guidelines) (P < .0005). When stratified by age, the 3 equations produce nearly identical glomerular filtration rate estimates in patients younger than 70 years (P = .989) but significantly different glomerular filtration rate estimates in patients from 70 to 104 years (P < .0005).
  
  
  CONCLUSIONS
  The Cockcroft-Gault equation systematically provides lower (more severe) estimates of renal function than the Modification of Diet in Renal Disease Study and Chronic Kidney Disease Epidemiology Collaboration equation in patients older than 70 years. However, significant differences in CKD staging derived from estimate of glomerular filtration rate or creatinine clearance were not observed in adults from 59 to 69 years of age. These findings do not validate one formula over the others, but demonstrate that disparities exist; it may be prudent to use the same formula over time in a given patient to monitor changes in renal function.
authors: Department of Medicine, Montefiore Medical Center (North Division), Bronx, NY, USA. dharmarajants@yahoo.com
authors: T S
authors: TS
authors: Dharmarajan
authors: Jinil
authors: J
authors: Yoo
authors: Robin O
authors: RO
authors: Russell
authors: Edward P
authors: EP
authors: Norkus
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006707:Homes for the Aged; D006801:Humans; D057187:Independent Living; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000178:diet therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011379:Prognosis; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D003404:Creatinine