Comparison of combined urea and creatinine clearance and prediction equations as measures of residual renal function when GFR is low

Almond, Alison; Siddiqui, Samira; Robertson, Sue; Norrie, John; Isles, Chris

doi:10.1093/qjmed/hcn032

Cited by 21 publications

(21 citation statements)

References 22 publications

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“…Although the groups seemed similar, the CCI may be inadequate to detect baseline differences in prognosis between the RRT and MCM patients. Although we attempted to eliminate lead time bias in our comparison of survival and used the four-variable MDRD equation, which has been shown to be the best available prediction equation for low GFRs (25), it has not been specifically validated in this age group. We did not investigate the role of psychosocial characteristics, symptom burden, quality of life, or comorbidity in patients' decisions to opt out of RRT.…”

Section: Discussionmentioning

confidence: 99%

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Carson

Juszczak

Davenport

et al. 2009

Clinical Journal of the American Society of Nephrology

394

388

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Background and objectives: There is ongoing growth of elderly populations with ESRD in Western Europe and North America. In our center, we offer an alternative care pathway of 'maximum conservative management' (MCM) to patients who elect not to start dialysis, often because of a heavy burden of comorbid illness and advanced age. The objective of our study was to compare clinical outcomes for patients who had ESRD and chose either MCM or renal replacement therapy (RRT).Design, setting, participants, & measurements: This is an observational study of a single-center cohort in the United Kingdom that evaluating 202 elderly (>70 yr) patients who had ESRD and had chosen either MCM (n ‫؍‬ 29) or RRT (n ‫؍‬ 173). We report survival, hospitalization rates, and location of death for this cohort. Survival was measured from a standardized 'threshold' estimated GFR of 10.

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Section: Discussionmentioning

confidence: 99%

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Carson

Juszczak

Davenport

et al. 2009

Clinical Journal of the American Society of Nephrology

394

388

View full text Add to dashboard Cite

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“…The 4-variable MDRD formula has not been tested very often in this patient population, and overestimation of residual renal function may occur in patients with significantly impaired function in up to 36% of cases [25]. Against this background, residual renal function was assessed combined with urea and creatinine clearance in our patients, as this is widely believed to be the most accurate non-invasive test for GFR in patients with decreased GFR.…”

Section: Discussionmentioning

confidence: 99%

Plasma Brain Natriuretic Peptide Levels in Cardiac Function Assessment in Chronic Dialysis Patients

et al. 2011

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Background: Brain natriuretic peptide (BNP) is elevated in patients with end-stage renal disease and could reflect left ventricular dysfunction. Aim: To evaluate the plasma levels of BNP in two groups of asymptomatic patients on different dialysis programs and to correlate their variations with echocardiographic parameters. Methods: Group A consisted of 36 patients on chronic hemodialysis (HD), and group B included 38 patients on continuous ambulatory peritoneal dialysis (CAPD). ECG and echocardiography were performed, and concomitantly plasma BNP levels were determined before and after a regular 4-hour session in HD patients and before performing a dialysate exchange in patients on CAPD. Results: BNP values in group A were found to be higher than in group B (419 ± 76 vs. 193 ± 56 pg/ml; p < 0.03). The cutoff point which discriminated both groups was 194 pg/ml (sensitivity: 64% and specificity: 76%; p = 0.001). Significant differences were found with respect to the following echocardiographic data (group A vs. group B): left atrial (LA) size (40 ± 13 vs. 34 ± 1 mm), LA volume (59 ± 16 vs. 41 ± 32 ml), transmitral flow E/A (1.17 ± 0.01 vs. 0.9 ± 0.06), the movement of the mitral valve annulus e/a (tissue Doppler imaging; 1.19 ± 0.15 vs. 1.05 ± 0.13) and left ventricular mass index (133 ± 10 vs. 108 ± 11). Conclusion: Patients on CAPD had lower levels of BNP, and echocardiographic findings indicated decreased volume overload. In asymptomatic patients, marked increases in BNP levels may reflect early stages of pathological processes that precede the development of apparent cardiac manifestations (left ventricular hypertrophy). Only echocardiographic parameters of cardiac dysfunction should be used as diagnostic criteria.

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“…We suggest that the triterpene ameliorates kidney function in diabetes from a marked increase in creatinine clearance despite the failure of OA to reduce elevated plasma urea concentrations of STZ-induced diabetic rats. Treatment-related increases in creatinine clearance indicate improvement of kidney function in experimental animals [32] and man [33] rather than urea because the latter varies with dietary protein. [34,35] Plasma creatinine concentration can therefore be used as a clinical chemistry end point to detect OA treatment-related effects on the kidney.…”

Section: Discussionmentioning

confidence: 99%

Renal Effects of Plant-Derived Oleanolic Acid in Streptozotocin-Induced Diabetic Rats

et al. 2009

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Previous studies from our laboratories indicate that the antidiabetic effects of Syzygium cordatum (Hochst.) [Myrtaceae] leaf extract in streptozotocin-induced diabetic rats may be attributed in part to mixtures of triterpenes, oleanolic acid (3ß-hydroxy-olea-12-en-28-oic acid, OA) and ursolic acid (3ß -hydroxyl-urs-12-en-28-oic acid, UA). For the bioactive compounds to have potential in diabetes management, they should alleviate or prevent complications of diabetes mellitus, kidney function, and cardiovascular disorders. This study was, therefore, designed to assess whether S. cordatum leaf derived OA influenced renal function evaluated by the ability to increase urinary Na + outputs parameters and creatinine clearance (Ccr) of streptozotocin (STZ)-induced diabetic rats. Extraction and fractionation of S. cordatum powdered leaf ethyl acetate-solubles (EAS) yielded mixtures of OA/UA and methyl maslinate/methyl corosolate. Recrystallization of OA/UA mixture using ethanol afforded OA, the structure of which was confirmed by NMR spectroscopy ( 1 H & 13 C). Acute effects of OA on kidney function and mean arterial blood pressure (MAP) were investigated in anesthetized rats challenged with hypotonic saline after a 3.5-h equilibration for 4h of 1 h control, 1.5 h treatment, and 1.5 h recovery periods. OA was added to the infusate during the treatment period. Chronic effects of OA were studied in individually caged rats treated twice daily with OA (60 mg/kg, p.o.) for five weeks. By comparison with respective control animals administration, OA significantly increased Na + excretion rates of non-diabetic and STZ-induced diabetic rats without affecting urine flow, K + and Cl − rates. At the end of five weeks, OA treatment significantly (p < 0.05) increased Ccr in non-diabetic (2.88 ± 0.14 vs. 3.71 ± 0.30 ml/min) and STZdiabetic rats (1.81 ± 0.32 vs. 3.07 ± 0.16 ml/min) with concomitant reduction of plasma creatinine concentration (n = 6 in all groups). OA also caused significant decreases in MAP in nondiabetic and STZ-induced diabetic rats. These findings suggest that OA may have beneficial effects on some processes associated with renal derangement of STZ-induced diabetic rats.

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Comparison of combined urea and creatinine clearance and prediction equations as measures of residual renal function when GFR is low

Cited by 21 publications

References 22 publications

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Plasma Brain Natriuretic Peptide Levels in Cardiac Function Assessment in Chronic Dialysis Patients

Renal Effects of Plant-Derived Oleanolic Acid in Streptozotocin-Induced Diabetic Rats

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