Estimation of glomerular filtration rate in hospitalised patients: are we overestimating renal function?

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State: Public
Version: Final published version
Serval ID
serval:BIB_22A5E24403C6
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Estimation of glomerular filtration rate in hospitalised patients: are we overestimating renal function?
Journal
Swiss medical weekly
Author(s)
Frank M., Guarino-Gubler S., Burnier M., Maillard M., Keller F., Gabutti L.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
19/12/2012
Peer-reviewed
Oui
Volume
142
Pages
w13708
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
QUESTIONS UNDER STUDY AND PRINCIPLES: Estimating glomerular filtration rate (GFR) in hospitalised patients with chronic kidney disease (CKD) is important for drug prescription but it remains a difficult task. The purpose of this study was to investigate the reliability of selected algorithms based on serum creatinine, cystatin C and beta-trace protein to estimate GFR and the potential added advantage of measuring muscle mass by bioimpedance.
In a prospective unselected group of patients hospitalised in a general internal medicine ward with CKD, GFR was evaluated using inulin clearance as the gold standard and the algorithms of Cockcroft, MDRD, Larsson (cystatin C), White (beta-trace) and MacDonald (creatinine and muscle mass by bioimpedance).
69 patients were included in the study. Median age (interquartile range) was 80 years (73-83); weight 74.7 kg (67.0-85.6), appendicular lean mass 19.1 kg (14.9-22.3), serum creatinine 126 μmol/l (100-149), cystatin C 1.45 mg/l (1.19-1.90), beta-trace protein 1.17 mg/l (0.99-1.53) and GFR measured by inulin 30.9 ml/min (22.0-43.3). The errors in the estimation of GFR and the area under the ROC curves (95% confidence interval) relative to inulin were respectively: Cockcroft 14.3 ml/min (5.55-23.2) and 0.68 (0.55-0.81), MDRD 16.3 ml/min (6.4-27.5) and 0.76 (0.64-0.87), Larsson 12.8 ml/min (4.50-25.3) and 0.82 (0.72-0.92), White 17.6 ml/min (11.5-31.5) and 0.75 (0.63-0.87), MacDonald 32.2 ml/min (13.9-45.4) and 0.65 (0.52-0.78).
Currently used algorithms overestimate GFR in hospitalised patients with CKD. As a consequence eGFR targeted prescriptions of renal-cleared drugs, might expose patients to overdosing. The best results were obtained with the Larsson algorithm. The determination of muscle mass by bioimpedance did not provide significant contributions.

Keywords
Aged, Aged, 80 and over, Algorithms, Creatinine/blood, Cystatin C/blood, Electric Impedance, Glomerular Filtration Rate, Humans, Inpatients/statistics & numerical data, Intramolecular Oxidoreductases/blood, Lipocalins/blood, Muscle, Skeletal/anatomy & histology, Prospective Studies, ROC Curve, Renal Insufficiency, Chronic/blood, Renal Insufficiency, Chronic/physiopathology, Reproducibility of Results, Switzerland
Pubmed
Web of science
Open Access
Yes
Create date
18/01/2013 16:07
Last modification date
20/08/2019 13:00
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