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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

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Published on: June 16, 2014

Renal function assessment in older adults.

A Clara Drenth-van Maanen1, Paul A F Jansen, Johannes H Proost

  • 1Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands; Expertise Centre Pharmacotherapy in Old persons (Ephor), Utrecht, The Netherlands.

British Journal of Clinical Pharmacology
|June 28, 2013
PubMed
Summary

The Cockcroft-Gault (CG) and CKD-EPI formulae best estimate glomerular filtration rate (GFR) in older adults, though all methods may misclassify kidney disease in individuals. This study compared GFR estimation methods in elderly patients.

Keywords:
Chronic Kidney Disease Epidemiology CollaborationCockcroft-GaultModification of Diet in Renal Disease formulafrail elderlyglomerular filtration rate

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Area of Science:

  • Nephrology
  • Geriatric Medicine
  • Clinical Chemistry

Background:

  • Glomerular filtration rate (GFR) estimation is crucial for managing chronic kidney disease (CKD).
  • Commonly used formulas include Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and CKD-EPI.
  • Accurate GFR estimation in older adults is challenging due to physiological changes.

Purpose of the Study:

  • To identify the most accurate formula for estimating GFR in individuals aged 70 years and older.
  • To compare the performance of CG, CG with ideal body weight (IBW), MDRD, and CKD-EPI against sinistrin clearance.

Main Methods:

  • A cross-sectional study involving 16 geriatric patients (≥70 years) with eGFR < 60 ml/min/1.73m².
  • Comparison of estimated GFR (eGFR) from CG, CG (IBW), MDRD, and CKD-EPI formulas against measured GFR via sinistrin clearance.
  • Renal function staged using NKF-KDOQI classification.

Main Results:

  • All formulas slightly overestimated GFR, with CG (+0.05) and CG (IBW) (+0.03) showing minimal overestimation.
  • Correct kidney disease classification rates were: CG (68.8%), CG (IBW) (75%), MDRD (43.8%), and CKD-EPI (68.8%).
  • CG (IBW) demonstrated the highest correct classification rate at 75%.

Conclusions:

  • CG and CKD-EPI formulas provide reasonable population-level GFR estimates in older adults.
  • Individual GFR misclassification by one stage is possible with all tested formulas.
  • CG with IBW showed the best performance in correctly classifying kidney disease stages in this cohort.