Renal function assessment in older adults

Abstract

AIMSThe Cockcroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD) and the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formulae are often used to estimate glomerular filtration rate (GFR). The objective was to determine the best method for estimating GFR in older adults. METHODSA cross-sectional study was conducted at the geriatric wards of two hospitals in The Netherlands. Patients aged 70 years or above with an estimated (e)GFR below 60 ml min −1 1.73 m −2 were included. The CG, CG calculated with ideal bodyweight (IBW), MDRD and CKD-EPI formulae were compared with a criterion standard, sinistrin clearance. Renal function was classified into five stages according to the National Kidney Foundation Disease Outcomes Quality Initiative chronic kidney disease classification, as follows (in ml min −1 1.73 m RESULTSSixteen patients, 50% male, with a mean age of 82 years (range 71-87 years) and mean body mass index 26 kg m −2 (range 18-36 kg m −2 ), were included. On average, all formulae slightly overestimated GFR, as follows (in ml min −1 1.73 m −2): CG +0.05 [95% confidence interval (CI) −28 to +28]; CG with IBW +0.03 (95% CI −20 to +20); MDRD +9 (95% CI −16 to +34); and CKD-EPI +5 (95% CI −20 to +29). They classified kidney disease correctly in 68.8% (CG), 75% (CG with IBW), 43.8% (MDRD) and 68.8% (CKD-EPI) of the participants, respectively. CONCLUSIONSThe CG, CG with IBW, MDRD and CKD-EPI formulae estimate the mean GFR of a population rather well. In individual cases, all formulae may misclassify kidney disease by one stage.

Inappropriate Medication in Non‐Hospitalized Patients With Renal Insufficiency: A Systematic Review

“…When specified, the decisions for the selection of these drugs were primarily based on frequency of use in the respective study population or on recommendations from experts, guidelines, or other consensus reports . Recommendations for adjustment of dosage or potential contraindications in renal insufficiency were assessed from varying sources such as online databases, drug dictionaries, or guidelines . Two articles provided no further information about underlying sources …”

“…Various equations exist for calculating GFR producing different results . The Cockcroft‐Gault equation is most common and has been in routine use in clinical practice since 1973 .…”

Mild chronic kidney disease is associated with cognitive function in patients presenting at a memory clinic

“…A recent study with a population of geriatric participants the MDRD showed an accuracy of 43.8% compared to the criterion standard, sinistrin clearance. The CG showed an accuracy of 68.8% (Drenth‐van Maanen et al , ). Major differences in CKD were observed between renal function estimated by these different equations at an individual patient level (Van Pottelbergh et al , ).…”

Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery

“… BMI, body mass index; CL CR , creatinine clearance. a Estimated from the equations of Cockcroft and Gault using ideal body weight instead of total body weight . ASA: Classification of the American Society of Anesthesiology of physical healthy: I – completely healthy fit patient; II – patient has mild systemic disease; III – patient has severe systemic disease that is not incapacitating; IV – patient has incapacitating disease that is a constant threat to life; V – a moribund patient who is not expected to live 24 h with or without surgery.…”