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[Creatinine clearance estimation in the extremely elderly subjects].

Shunichi Hirayama1, Reiko Kikuchi, Shinichiro Inoue

  • 1Tokyo University of Pharmacy and Life Science.

Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
|March 6, 2007
PubMed
Summary

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The Cockcroft and Gault formula best predicts creatinine clearance in elderly patients, though it underestimates values in extremely elderly women. This is crucial for medication management in older adults.

Area of Science:

  • Gerontology
  • Nephrology
  • Clinical Pharmacology

Background:

  • Elderly outpatients often manage polypharmacy, taking an average of six or more medications.
  • Accurate assessment of kidney function is vital for safe and effective drug dosing in this population.

Purpose of the Study:

  • To identify the optimal formula for estimating creatinine clearance in elderly individuals.
  • To address the challenges of 24-hour urine collection in this demographic.

Main Methods:

  • Compared four creatinine clearance estimation formulas: Cockcroft and Gault, Yasuda, Orita, and Walser.
  • Utilized serum creatinine data from 143 elderly inpatients (mean age 82.9 years), including 67 extremely elderly individuals.
  • Analyzed data stratified by age and sex.

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Main Results:

  • The Cockcroft and Gault formula demonstrated the strongest correlation with measured creatinine clearance (r=0.74 in the extremely elderly, r=0.76 in those under 85).
  • However, this formula tended to underestimate creatinine clearance in extremely elderly women.

Conclusions:

  • The Cockcroft and Gault equation is the preferred method for estimating creatinine clearance in most elderly patients.
  • Clinical caution is advised when using this formula for extremely elderly women due to potential underestimation.