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Factors Affecting Renal Clearance: Renal Impairment01:17

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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
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The glomerular filtration rate (GFR) is a critical indicator of kidney health, reflecting how well the kidneys filter blood. Changes in GFR can signal potential kidney impairment, necessitating accurate measurement methods to monitor kidney function effectively.Various molecules can serve as markers for GFR measurement, with the ideal marker meeting several specific criteria. It must freely filter at the glomerulus, avoid reabsorption or secretion by the renal tubules, remain unmetabolized, not...
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Estimation of Sex- and Age-Specific Reference Values for Serum Creatinine Using Three Indirect Methods in a

Anne Meyer1, Oana R Oprea2, Robert Müller1

  • 1Medical Department, Abbott GmbH, Wiesbaden, Germany.

The Journal of Applied Laboratory Medicine
|March 3, 2026
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Summary

This study developed age- and sex-specific serum creatinine reference intervals (RIs) using indirect methods in Romania. Locally derived RIs may improve patient care by reflecting population-specific differences better than manufacturer RIs.

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Biostatistics

Background:

  • Serum creatinine reference intervals (RIs) are crucial for diagnosing kidney disease.
  • Manufacturer-provided RIs may not accurately reflect diverse patient populations.
  • Indirect statistical methods offer an alternative for establishing population-specific RIs.

Purpose of the Study:

  • To estimate age- and sex-specific serum creatinine RIs using indirect methods in Romania.
  • To compare the clinical relevance of these derived RIs with manufacturer-provided RIs.
  • To evaluate the impact of local RIs on patient care.

Main Methods:

  • Retrospective data collection from 6 Romanian laboratories.
  • Application of three indirect statistical methods: RefLim, truncated maximum likelihood (TML), and refineR.
  • Data preprocessing to exclude repeated measurements and high-risk samples; stratification by age, sex, and clinical setting.

Main Results:

  • Identified clear age-related patterns in serum creatinine levels for both males and females.
  • Derived upper RIs for females were 15-20% lower than manufacturer RIs.
  • Established creatinine medians differed from European Kidney Function Consortium (EKFC) equation Q values, particularly in certain age groups.

Conclusions:

  • Indirect methods can capture population-specific creatinine variations missed by manufacturer RIs.
  • Rigorous data preprocessing is essential for reliable indirect RI derivation.
  • Locally derived RIs, especially for specific age groups, may enhance clinical decision-making and patient care.