Estimation of Glomerular Filtration Rate in Older Patients with Chronic Renal Insufficiency: Is the Modification of Diet in Renal Disease Formula an Improvement?

Lamb, Edmund J.; Webb, Michelle; Simpson, David; Coakley, A. J.; Newman, David J.; O'Riordan, Shelagh E

doi:10.1046/j.1365-2389.2003.51330.x

Cited by 139 publications

(96 citation statements)

References 29 publications

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“…In this study employing 51 Cr-EDTA radioisotope method, CGF, MDRD1, and CrCl formulas were compared in a patient group consisting of 52 patients at an age range of 69-92 years and all three formulas had high correlations with the radioisotopic method (r = 0.84, r = 0.84, and r = 0.73, respectively). 8 In this study, similar to our study, the correlation with CGF and MDRD1 was similar while the correlation with CrCl was of lesser degree.…”

Section: Discussionsupporting

confidence: 90%

Comparison of Different Glomerular Filtration Methods in the Elderly: Which Formula Provides Better Estimates?

et al. 2012

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Objectives: Technetium-99m diethylenetriaminepentaacetic acid ( 99m Tc-DTPA) is an ideal radioisotopic method having a high correlation with inulin clearance for the determination of glomerular filtration rate (GFR). Different formulas like creatinine clearance (CrCl) in 24 h urine samples, Cockroft-Gault formula (CGF), and modification of diet in renal disease (MDRD) are being used to come up with an estimate. In this study, we compared 99m Tc-DTPA with the formulas mentioned above in an attempt to best identify the method that would yield the nearly ideal GFR estimates in the elderly. Materials and methods:In 76 patients who were admitted to our clinic, we measured 24 h urine volume (V), urine creatinine (Ucr), and serum creatinine (Scr) levels together with CrCl, Scr, serum urea (Su), and albumin (Alb) levels. By using coefficients identified for age, gender, and race, we calculated modification of diet in renal disease 1 (MDRD1). Different from MDRD1, we calculated modification of diet in renal disease 2 (MDRD2) that does not include Su and Alb parameters and formulas like CGF that include Scr, age, gender, and weight parameters to come up with GFR levels. All patients underwent 99m Tc-DTPA procedure. Results: The mean of the GFR values measured by 99m Tc-DTPA was 54.3 ± 19.9. The means of GFR values calculated by CrCl, MDRD1, MDRD2, and CGF were 58.0 ± 30.5, 60.9 ± 22.1, 54.4 ± 20.1, and 57.9 ± 22.4, respectively. GFR as measured by 99m Tc-DTPA showed statistically significant correlations with the results of other methods (p < 0.001 for all methods). The most significant correlation was with MDRD1. Conclusion: MDRD1 can be used for next to ideal and accurate predictions of GFR in the elderly in the daily practice.

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Section: Discussionsupporting

confidence: 90%

Comparison of Different Glomerular Filtration Methods in the Elderly: Which Formula Provides Better Estimates?

et al. 2012

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“…It is possible that entry of these variables into the MDRD formula could alter the association of CKD and the dependent variable or create interaction terms in our multivariate models. Also, the MDRD formula has not been well validated in geriatric populations and has been shown to overestimate the GFR of elderly individuals (36,37). Therefore, the association between CKD and hip fracture may have been biased depending on the direction of case misclassification.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States

Nickolas

McMahon

Shane

2006

Journal of the American Society of Nephrology

339

218

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People with ESRD are at a high risk for hip fracture. However, the effect of moderate to severe chronic kidney disease (CKD) on hip fracture risk has not been well studied. As part of the Third National Health and Nutrition Examination Survey, information on both kidney function and history of hip fracture was obtained. This survey is a complex, multistage, probability sample of the US noninstitutionalized civilian population and was conducted between 1988 and 1994. A history of hip fracture was identified from the response to a questionnaire that was administered to all participants. There were 159 cases of hip fracture. There was a significantly increased likelihood of reporting a hip fracture in participants with estimated GFR <60 ml/min (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.18 to 3.80). In younger participants (aged 50 to 74 yr), the prevalence of CKD was approximately three-fold higher in those with a history of hip fracture versus in those without a history of hip fracture (19.0 versus 6.2%, respectively; P ‫؍‬ 0.04). In multivariate logistic regression analysis, only the presence of CKD (OR 2.32; 95% CI 1.13 to 4.74), a reported history of osteoporosis (OR 2.52; 95% CI 1.08 to 5.91), and low physical activity levels (OR 2.10; 95% CI 1.03 to 4.27) were associated with a history of hip fracture. There is a significant association between hip fracture and moderate to severe degrees of CKD, particularly in younger individuals, that is independent of traditional risk factors for hip fracture.

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“…In clinical practice, GFR is rarely measured, since it is expensive and requires the use of radioelements for isotopic clearance determination, therefore renal function is assessed by the determination of creatinine clearance (CrCl). Measured-CrCl has been used as the reference method since direct measurement of GFR using isotopic clearance is difficult to perform in elderly patients, and it is recognized to be a reliable estimate of GFR in older individuals (3). Nevertheless, the number of lung cancer patients older than 80 years evaluated for CrCl in previous studies has been too small (4,5).…”

Section: Introductionmentioning

confidence: 99%

Age-dependent decline in renal function in patients with lung cancer

et al. 2012

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Abstract. The aim of this study was to clarify the effect of aging on renal function. Serum creatinine (SCr), blood urea nitrogen (BUN) and 24-h creatinine clearance (measuredCrCl) were examined in lung cancer patients and the measured-CrCl were compared with CrCl estimates by employing two commonly used equations. In total, 787 lung cancer patients who were diagnosed between 2001 and 2010 were retrospectively analyzed. SCr and urine creatinine, BUN and measured-CrCl were evaluated prior to treatment. The Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) formulae were also used to estimate CrCl. SCr, BUN and measured-CrCl showed a significant decline in the elderly. In the 787 lung cancer patients, a significant correlation coefficient was found between measured-CrCl and age. However, in patients aged 80 years or older, no significant correlation coefficient was found between measured-CrCl and age. In the comparison between the measured CrCl and the CrCls estimated by the two formulae, the CG-CrCl levels were lower than those of the measured-CrCl, whereas the MDRDCrCl levels were higher. Age is a crucial factor influencing renal function in patients with lung cancer. Particularly in the elderly, a decline in CrCl and greater individual variability in CrCl, as well as discrepancies in measured-CrCl and estimated CrCls are significant factors.

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Estimation of Glomerular Filtration Rate in Older Patients with Chronic Renal Insufficiency: Is the Modification of Diet in Renal Disease Formula an Improvement?

Abstract: Calculated estimates of GFR are an improvement over ClCr estimation. On balance, the MDRD formula does not improve the estimate of GFR compared with the Cockcroft and Gault formula in older Caucasian patients with chronic renal insufficiency.

Cited by 139 publications

References 29 publications

Comparison of Different Glomerular Filtration Methods in the Elderly: Which Formula Provides Better Estimates?

Comparison of Different Glomerular Filtration Methods in the Elderly: Which Formula Provides Better Estimates?

Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States

Age-dependent decline in renal function in patients with lung cancer

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