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Screening for renal disease using serum creatinine: who are we missing?
L Duncan1, J Heathcote, O Djurdjev
1Division of Nephrology, Department of Medicine, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada V6Z 1Y6.
Summary
Many patients have reduced kidney function despite normal serum creatinine (SCr) levels. Calculating glomerular filtration rate (GFR) using the Cockcroft-Gault (C-G) formula can help identify renal insufficiency early.
Area of Science:
- Nephrology
- Clinical Chemistry
- Primary Care Medicine
Background:
- Early detection of renal disease is crucial for patient management and timely referral.
- Serum creatinine (SCr) is a common screening tool for renal dysfunction.
- Normal SCr levels can mask significantly decreased glomerular filtration rates (GFR), hindering early diagnosis.
Purpose of the Study:
- To estimate the prevalence of patients with significantly reduced GFR, calculated by the Cockcroft-Gault (C-G) formula, who present with normal SCr levels.
- To highlight the potential for early identification of renal impairment through GFR estimation.
Main Methods:
- Analysis of data from 2781 outpatients referred for SCr measurement.
- GFR was estimated using the Cockcroft-Gault (C-G) formula.
- Patients were categorized based on the concordance of SCr levels and C-G calculated GFR (< or =50 ml/min indicating substantial impairment).
Main Results:
- 15.2% of patients (387/2543) with normal SCr levels exhibited a C-G calculated GFR < or =50 ml/min.
- Among those with normal SCr, impaired GFR was more prevalent in older age groups (47.3% in >=70 years).
- Historical data revealed that a significant proportion of patients with abnormal SCr and GFR had normal SCr values two years prior.
Conclusions:
- A substantial number of patients with normal SCr levels demonstrate significantly impaired renal function.
- Routine reporting of calculated GFR estimates alongside SCr could improve early detection of renal impairment.
- This approach aids primary care physicians in identifying at-risk patients for timely intervention.