The older adult patient and kidney function.
OBJECTIVE
Many older adults have decreased kidney function. Practitioners should be informed that no single clinical assessment method is validated in predicting their kidney function.


METHODS
Primary literature identified through MEDLINE/PubMed (1950-2010) and EMBASE (1980-2010) databases. The search was limited to English language, human subjects, and individuals 65 years of age and older.


METHODS
Research, review articles, and additional publications related to geriatric, elderly, kidney function assessment, and cystatin C.


RESULTS
Screening and diagnosing chronic kidney disease are a challenge in older adults partially because of muscle loss and frailty. The various tools used to estimate creatinine clearance (Clcr) are not validated and may lead to under- or overdiagnosis of kidney function. The clinician must be cautious when using and interpreting results from these values.


RESULTS
Estimating the glomerular filtration rate (eGFR) with either the Modification of Diet in Renal Disease (MDRD) or Cockcroft-Gault (Clcr) formulae yielded better predictions of kidney function when compared with creatinine alone, or to measured Clcr. These estimation methods should be used in clinical practice to provide a better estimation of kidney function in older adults until a more valid assessment tool becomes available.


CONCLUSIONS
There is no proven valid method for eGFR in older adults; however, the CG and MDRD equations are routinely applied in clinical practice. Kidney function assessment in older adults remains a challenge, and practitioners should know their limitations.
Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY 11201, USA. timothy.nguyen@liu.edu
Timothy V
TV
Nguyen
David S
DS
Goldfarb
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D016330:Frail Elderly; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007674:Kidney Diseases / Q000503:physiopathology*; D007677:Kidney Function Tests / Q000379:methods