UNDERDIAGNOSIS OF IMPAIRED KIDNEY FUNCTION IN OLDER ADULTS WITH NORMAL SERUM CREATININEписьмо
Аннотация: To the Editor: We read with great interest the article by Giannelli et al.1 examining the magnitude of renal function misclassification in a community-dwelling elderly population. The method used to classify subjects into moderate renal impairment (glomerular filtration rate (GFR)<60 mL/min as established by the Kidney Disease Outcome Quality Initiative of the National Kidney Foundation (NKF-K/DOQI)2) was the Cockcroft Gault (CG) equation and calculated creatinine clearance (CrCl). We salute the authors for reemphasizing the importance of accurately identifying subjects with chronic kidney disease (CKD), but we would like to comment on the methods used. As emphasized by the NKF-K/DOQI, “measurement of creatinine clearance does not improve on the estimate of GFR by prediction equations.”2 Nevertheless, all recommended GFR estimation equations have been criticized for inaccuracy and have not been validated or compared in an elderly population. We have therefore recently compared three equations3 in a community-living elderly population: the CG equation, the Modification of Diet in Renal Disease (MDRD) formula, and the new Mayo Clinic equation (developed by Rule et al.4 to overcome the shortcomings of the previous equations). Of 441 subjects aged 70 years old, all meeting the criteria for normal serum creatinine used by Giannelli et al., the rate of moderate renal impairment (estimated GFR (eGFR) <60 mL/min per 1.73 m2) according to the different equations was 29.4% using the CG equation, 12.5% using the MDRD formula, and 1.3% using the Mayo Clinic equation. It is evident that the magnitude of possible misclassification is large and highly dependent on the equation used. There are currently no data to validate any of these equations in the elderly population, although, as recently reported,3 for the following reasons, the Mayo Clinic equation was found to reduce misclassification of CKD and better predict related all-cause mortality: It identified the group of subjects having low eGFR to be one third the number identified using the CG and approximately half the number identified using the MDRD formula. The prediction of mortality in those with reduced kidney function (<60 mL/min per 1.73 m2) was significantly better than that of the CG equation or the MDRD formula. Subjects with higher eGFR (≥60 mL/min per 1.73 m2) had a much higher average value than found using the MDRD or the CG. We therefore suggest that the Mayo Clinic equation is a better formula for classification of elderly subjects with CKD. Conflict of Interest: The editor in chief has reviewed the authors' personal and financial conflict of interest checklist and has determined that none have any conflicts related to this letter. Author Contributions: Yoram Maaravi: concept and design, data analysis, and primary author. Michael Burzstyn and Jochanan Stessman: concept and design, criticism and suggested improvement of data analysis, and content of letter. Sponsor's Role: None.
Год издания: 2008
Авторы: Yoram Maaravi, Michael Burzstyn, Jochanan Stessman
Издательство: Wiley
Источник: Journal of the American Geriatrics Society
Ключевые слова: Chronic Kidney Disease and Diabetes, Dialysis and Renal Disease Management, Renal and Vascular Pathologies
Другие ссылки: Journal of the American Geriatrics Society (PDF)
Journal of the American Geriatrics Society (HTML)
PubMed (HTML)
Journal of the American Geriatrics Society (HTML)
PubMed (HTML)
Открытый доступ: bronze
Том: 56
Выпуск: 2
Страницы: 382–382