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Age-dependent error in creatinine clearance estimated by Cockcroft-Gault equation for the elderly patients in a

Mitsuhiro Matsuo1, Fuminori Yamagishi2

  • 1Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan. matsuo@itoigawa-hp.jp.

Journal of Anesthesia
|January 4, 2019
PubMed

Insights

The Cockcroft-Gault equation underestimates creatinine clearance in elderly Japanese patients, particularly those over 65. A modified equation significantly improved accuracy, highlighting potential risks for anesthesiologists and intensivists.

Area of Science:

  • Nephrology
  • Geriatric Medicine
  • Clinical Pharmacology

Background:

  • Accurate estimation of kidney function is crucial for drug dosing and patient management.
  • The Cockcroft-Gault (CG) equation is widely used to estimate creatinine clearance (CCr).
  • Limited data exist on the CG equation's accuracy in elderly Asian populations.

Purpose of the Study:

  • To evaluate the accuracy of the CG equation for estimating CCr in elderly Japanese patients.
  • To assess the impact of age on the CG equation's performance.
  • To explore modifications to improve CCr estimation in this demographic.

Main Methods:

  • Retrospective chart review of 1028 Japanese patients aged ≥55 years.
  • Comparison of CCr measured by 24-hour urine collection with CCr estimated by the CG equation.
  • Analysis of age-dependent discrepancies and evaluation of a modified CG equation.

Main Results:

  • The CG equation significantly underestimated CCr in elderly Japanese patients (mean difference: -7.3 mL/min).
  • Underestimation was age-dependent, increasing with age, reaching -21.7 mL/min in patients ≥90 years.
  • A modified CG equation, treating age ≥65 as 65, largely eliminated age-dependent errors.

Conclusions:

  • The standard CG equation is inaccurate for estimating CCr in elderly Japanese patients, particularly the very old.
  • A modified CG equation demonstrates improved accuracy for this population.
  • Clinicians, especially anesthesiologists and intensivists, must be aware of potential kidney function underestimation when using the CG equation in elderly Japanese patients.

Keywords:
24-h urine collectionAgedBiasKidney functionPreoperative evaluation

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