Abstract
PurposeIn a daily clinical practice, glomerular filtration rate (GFR) is still estimated on the basis of short MDRD formula, whereas medications’ Summaries of Product Characteristics suggest that GFR used for the dosage adjustment should be estimated based on the Cockcroft–Gault (C–G) equation. The aim of the study was to compare eGFR values calculated on the basis of short and full MDRD and C–G equations in PolSenior study participants with decreased eGFR.MethodsWe have assessed differences in the estimation of GFR between short and full MDRD, as well as C–G formula, all equations utilizing non-isotope-dilution mass spectrometry-calibrated measurements of serum creatinine, in the community-based population of 760 persons aged 65 years or above (mean age 82 ± 8 years) with estimated GFR < 60 ml/min/1.73 m2 (according to short MDRD). In addition, in our analysis, we have included the detailed characteristics of comorbidities and different aspects of mobility and functional performance.ResultsThe better concordance, precision, and accuracy with MDRD short formula were found for MDRDfull than C–G equation. In logistic regression analysis, female gender, activities in daily living (ADL) ≤ 4, and age > 80 years diminished, while visceral obesity improved accuracy (P30) of eGFR calculated according to C–G equation as compared to MDRDshort. Similar analysis did not found factors influencing P30 for MDRDfull equation.ConclusionsIn very old subjects, especially females, dependent patients and those with visceral obesity, estimation of GFR based on short MDRD formula should not be used interchangeably with Cockcroft–Gault equation for the medicines dose tailoring.
Highlights
The accurate estimation of renal function in older patients remains a serious challenge
For the accuracy of eGFR calculated according to C–G equation as compared to MDRDshort, showed that female gender, activities in daily living (ADL) ≤ 4, and age > 80 years were factors diminishing accuracy (P30), while visceral obesity improved accuracy (Table 4)
As the possible clinical consequences of discrepancies between eGFR values calculated with different formulas are most relevant among patients with substantially diminished renal excretory function, we have focused on the subgroup of patients with short MDRD eGFR < 60 ml/ min/1.73 m2
Summary
The accurate estimation of renal function in older patients remains a serious challenge. The estimation was based on the Cockcroft–Gault (C–G) formula [1], regardless of noticeable limitations [2]. To mention just a few, the C–G formula underestimates GFR in slim and overestimates GFR in obese older patients [3]. Low muscle mass (sarcopenia) and decreased daily creatinine production explains the bias in GFR estimation [4]. It should be stressed that the C–G formula has never been validated in an older population. A newer equation, the MDRD formula, was introduced in late 1990s as a result
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