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Renal function and ultrasound imaging in elderly subjects
Luca Zanoli1, Giulia Romano1, Marcello Romano2
1Department of Internal Medicine, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy.
Thescientificworldjournal
|December 31, 2014
Summary
The Cockcroft-Gault formula effectively identifies chronic kidney disease (CKD) in elderly individuals, outperforming other formulas. Combining it with renal ultrasound (r-US) further enhances CKD detection in this population.
Area of Science:
- Nephrology
- Geriatrics
- Medical Imaging
Background:
- Accurate detection of chronic kidney disease (CKD) is crucial in the elderly population.
- Existing glomerular filtration rate (GFR) formulas may have limitations in estimating kidney function in older adults.
- Renal ultrasound (r-US) offers insights into renal morphology that might complement functional assessments.
Purpose of the Study:
- To assess the efficacy of various GFR formulas in identifying CKD among elderly subjects.
- To investigate the relationship between renal morphology (assessed by r-US) and kidney function.
- To determine the added value of combining r-US with GFR formulas for CKD detection.
Main Methods:
- Evaluation of GFR formulas (Cockcroft-Gault, MDRD, CKD-EPI) for CKD discrimination in 72 elderly patients (mean age 80±7 years).
- Correlation analysis between renal morphology parameters (e.g., kidney volume, sinus section area) and GFR.
- Multivariate analysis incorporating r-US findings and GFR values to identify predictors of CKD.
Main Results:
- The Cockcroft-Gault formula demonstrated the highest sensitivity (78%) and specificity (94%) for CKD detection.
- Cockcroft-Gault results showed a significant correlation with kidney volume (R=0.68, P<0.001).
- Multivariate analysis identified Cockcroft-Gault <52 mL/min and kidney sinus section area <28 cm² as highly accurate predictors of CKD (AUC 0.90, P<0.001).
- MDRD and CKD-EPI formulas showed significant differences for GFR ≥90 mL/min, indicating potential unreliability.
- All tested GFR formulas struggled to provide a consistently reliable GFR estimate.
Conclusions:
- The Cockcroft-Gault formula, particularly with a threshold of <52 mL/min, is effective in discriminating CKD in the elderly.
- Despite its discriminatory ability, the Cockcroft-Gault formula, like others, does not provide a reliably accurate GFR estimate.
- The integration of r-US findings with the Cockcroft-Gault formula significantly enhances the detection of CKD in elderly individuals.
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