Analysis of Reciprocal Creatinine Plots in Renal Failure

Kirschbaum, Barry B.

doi:10.1097/00000441-198606000-00006

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…Contrary to some previous studies [9, 17, 18], we found that reciprocal creatinine plot could be extrapolated in patients with advanced renal insufficiency. However, there could be potential bias in the present study because only those interim plots with at least five points and Pearson's correlation coefficient above 0.9 were extrapolated.…”

Section: Discussioncontrasting

confidence: 99%

Extrapolation of reciprocal creatinine plot is not reliable in predicting the onset of dialysis in patients with progressive renal insufficiency

Szeto

Leung

Wong

et al. 2003

Journal of Internal Medicine

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. Szeto C.‐C, Leung C.‐B, Wong T.Y.‐H, Chow K.‐M, Wang A.Y.‐M, Lui S.‐F, Li P.K.‐T (Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China). Extrapolation of reciprocal creatinine plot is not reliable in predicting the onset of dialysis in patients with progressive renal insufficiency. J Int Med 2003; 253: 335–342. Background. Reciprocal creatinine plot is often used to monitor patients with progressive renal insufficiency and to predict the onset of dialysis, although the latter practice has not been validated. Objective. We examined whether extrapolating the reciprocal creatinine plot can predict the onset of dialysis. Setting. Single centre study in the dialysis unit of a University teaching hospital. Design. We studied 170 consecutive patients with progressive renal insufficiency referred to a single nephrology unit and subsequently dialysed. Reciprocal creatinine plot was constructed by all available serum creatinine values before dialysis (the ‘definitive plot’). Four ‘interim plots’ were constructed for each patient by using serum creatinine below 400, 500, 600 and 700 μmol L−1. Interim plots with at least five points and Pearson's r > 0.9 were analysed. The date of dialysis was predicted from the least squares linear regression formula and a target serum creatinine level cor‐ responding to estimated creatinine clearance of 7 mL min−1, at which dialysis was recommended. Results. The median duration of observation was 25 months. After serum creatinine 500 μmol L−1, the slope of the interim plot remained stable and extrapolation was possible in 117 patients (68.8%). However, the limits of agreement for predicting the onset of dialysis were wide (from −11.7 to +9.5 months). At this creatinine level, the onset of dialysis fell within 1 month of the predicted onset in only 41 patients (24.1%). The limits of agreement for prediction narrowed when time points of higher serum creatinine were included into the plot. However, nine patients (5.3%) required dialysis within 1 month at creatinine 600 μmol L−1 and the dialysis was not predicted by the reciprocal creatinine plot. Target serum creatinine did not correlate with acute serum creatinine at which dialysis was started (r = 0.051, P = 0.51). A slower decline in renal function was associated with a higher prediction error (r = 0.212, P = 0.014). Conclusions. The onset of dialysis cannot be predicted by extrapolation of the reciprocal creatinine plot because of individual variation in the renal function that require dialysis. Dialysis would be almost imminent in some patients by the time serum creatinine reaches a level that allows accurate construction and extrapolation of a plot.

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Section: Discussioncontrasting

confidence: 99%

Extrapolation of reciprocal creatinine plot is not reliable in predicting the onset of dialysis in patients with progressive renal insufficiency

Szeto

Leung

Wong

et al. 2003

Journal of Internal Medicine

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“…1 Once the renal failure is well established, the rate of progression can be estimated, although limitations exist. [2][3][4][5][6][7][8][9] Many features are common to progression of renal failure of various causes, and the final histologic appearance is one of glomerulosclerosis, interstitial fibrosis, and loss of native renal cells. Nevertheless, the causes of chronic renal failure are heterogeneous, and the mechanisms and lo-cations of the initial injury may vary.…”

mentioning

confidence: 99%

Progression of Chronic Renal Failure

2003

Arch Intern Med

121

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Chronic renal failure is characterized by a persistently abnormal glomerular filtration rate. The rate of progression varies substantially. Several morphologic features are prominent: fibrosis, loss of native renal cells, and infiltration by monocytes and/or macrophages. Mediators of the process include abnormal glomerular hemodynamics, hypoxia, proteinuria, hypertension, and several vasoactive substances (ie, cytokines and growth factors). Several predisposing host factors may also contribute to the process. Treatments to delay progression are aimed at treating the primary disease and at strictly controlling the systemic blood pressure and proteinuria. The role of antihypertensive agents, statins, and use of other maneuvers such as protein restriction and novel approaches are also discussed herein.

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“…The search for breakpoints provides a good means of analyzing the clinical course of patients with renal disease and of detecting factors that are temporally related to an alteration in disease activity. 15,16 Moreover, in larger studies, serum creatinine has been considered as an appropriate measure of renal function in surgical patients. 5,17 Thus, the choice of a 20% increase in serum creatinine after EVR as a definition of postoperative RI appears clinically relevant.…”

Section: Discussionmentioning

confidence: 99%