Skip to main content

Advertisement

SpringerLink
Log in

Age-dependent error in creatinine clearance estimated by Cockcroft–Gault equation for the elderly patients in a Japanese hospital: a cross-sectional study

  • Short Communication
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

The aim of this study is to assess the accuracy of creatinine clearance (CCr) calculated by the Cockcroft–Gault (CG) equation for elderly patients in a Japanese hospital. This study was a retrospective chart review of patients aged ≥ 55 years with a CCr measurement by a 24-h urine collection (24-h) prior to general surgery in our hospital between April 2009 and March 2017. In total, 1028 Japanese patients were included (mean age 73.0 ± 8.9 years). The serum creatinine value was 0.82 ± 0.24 mg/dL. The CCr estimated by CG and measured by 24 h was 64.2 ± 20.9 mL/min and 71.5 ± 21.0 mL/min, respectively. The CG CCr was significantly underestimated in patients aged ≥ 65 years, and the discrepancy exhibited an age-dependent character. The error was reached at 21.7 ± 13.2 mL/min in patients aged ≥ 90 years (P < 0.001). The age-dependent errors almost completely disappeared when the modified CG equation was used, in which the term of age in the original CG equation was constantly regarded as 65, if the patient was 65 years or older. Anesthesiologists and intensivists should pay attention to the potential risk of underestimating kidney function when using the CG equation for Japanese elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.

    Article  Google Scholar 

  2. Baldea AJ. Effect of aging on renal function plus monitoring and support. Surg Clin N Am. 2015;95:71–83.

    Article  PubMed  Google Scholar 

  3. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.

    Article  CAS  PubMed  Google Scholar 

  4. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.

    Article  CAS  PubMed  Google Scholar 

  5. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  7. Raman M, Middleton RJ, Kalra PA, Green D. Estimating renal function in old people: an in-depth review. Int Urol Nephrol. 2017;49:1979–88.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Verhave JC, Fesler P, Ribstein J, du Cailar G, Mimran A. Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis. 2005;46:233–41.

    Article  CAS  PubMed  Google Scholar 

  9. Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft–Gault equation. Pharmacotherapy. 2012;32:604–12.

    Article  CAS  PubMed  Google Scholar 

  10. Demirovic JA, Pai AB, Pai MP. Estimation of creatinine clearance in morbidly obese patients. Am J Health Syst Pharm. 2009;66:642–8.

    Article  CAS  PubMed  Google Scholar 

  11. Chaverri-Fernández JM, Zavaleta-Monestel E, Díaz-Madriz JP, Ortiz-Ureña A, Ramírez-Hernández M, Trejos-Morales K. Analysis of the concordance between the estimated values of creatinine clearance using the Cockcroft–Gault equation and the real value determined in patients from the Hospital Clínica Bíblica. Farm Hosp. 2016;40:3–13.

    PubMed  Google Scholar 

  12. Hubner RA, Goldstein R, Mitchell S, Jones A, Ashley S, O’Brien ME, Popat S. Influence of co-morbidity on renal function assessment by Cockcroft–Gault calculation in lung cancer and mesothelioma patients receiving platinum-based chemotherapy. Lung Cancer. 2011;73:356–60.

    Article  CAS  PubMed  Google Scholar 

  13. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28:830–8.

    Article  CAS  PubMed  Google Scholar 

  14. Stevens LA, Coresh J, Feldman HI, Greene T, Lash JP, Nelson RG, Rahman M, Deysher AE, Zhang YL, Schmid CH, Levey AS. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol. 2007;18:2749–57.

    Article  PubMed  Google Scholar 

  15. Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R, Townsend R, Okparavero A, Zhang YL, Schmid CH, Levey AS, Chronic Kidney Disease Epidemiology Collaboration. Chronic Kidney Disease Epidemiology Collaboration. Comparison of drug dosing recommendations based on measured GFR and kidney function estimating equations. Am J Kidney Dis. 2009;54:33–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kanda I, Kawasaki A, Morita R, Musha M, Sakurada T, Kobayashi E, Satoh N. Survey on “renal function” information in the package inserts of prescription drugs (in Japanese with English abstract). Jpn J Clin Pharmacol Ther. 2013;44:313–8.

    Article  CAS  Google Scholar 

  17. Miller WG, Myers GL, Ashwood ER, Killeen AA, Wang E, Thienpont LM, Siekmann L. Creatinine measurement: state of the art in accuracy and interlaboratory harmonization. Arch Pathol Lab Med. 2005;129:297–304.

    CAS  PubMed  Google Scholar 

  18. Dowling TC, Wang ES, Ferrucci L, Sorkin JD. Glomerular filtration rate equations overestimate creatinine clearance in older individuals enrolled in the Baltimore Longitudinal Study on Aging: impact on renal drug dosing. Pharmacotherapy. 2013;33:912–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan

    Mitsuhiro Matsuo

  2. Department of Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan

    Fuminori Yamagishi

Authors
  1. Mitsuhiro Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fuminori Yamagishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MM designed and performed the research; preparing manuscript was supervised by YF.

Corresponding author

Correspondence to Mitsuhiro Matsuo.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsuo, M., Yamagishi, F. Age-dependent error in creatinine clearance estimated by Cockcroft–Gault equation for the elderly patients in a Japanese hospital: a cross-sectional study. J Anesth 33, 155–158 (2019). https://doi.org/10.1007/s00540-018-2596-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-018-2596-3

Keywords

Search

Navigation