Skip to main content
SpringerLink
Log in

Comparison between the Three Most Popular Formulae to Estimate Renal Function, in Subjects 75 Years of Age or Older

  • Short Communication
  • Published:
Drugs & Aging Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Objectives

The aim of the study was to compare the accuracy of three formulae that estimate creatinine clearance (CLCR), in elderly hospitalized patients: the Cockcroft–Gault (CG) formula and the Modification of Diet in Renal Disease formulae with 4 and 6 variables (MDRD4 and MDRD6).

Methods

A prospective, cross-sectional, observational study was conducted in four hospital geriatric wards. Consecutive patients admitted to the wards who were aged ≥75 years and had an indwelling urinary catheter for the purpose of care were eligible for enrolment. CLCR was determined via four methods: measurement of CLCR from plasma and urine creatinine plus 24-h urine volume; the CG formula; and the MDRD4 and MDRD6 formulae. Moderate and severe renal impairments were defined as a CLCR of 30.0–59.9 and <30.0 mL/min, respectively.

Results

A total of 157 patients were included. Their mean age (±SD) was 86.5 ± 6.1 (range 75–105) years and 46.5 % were male. The median values and interquartile ranges (IQRs) (in mL/min) were 44.0 (IQR 32.1–64.5) for measured CLCR, 42.1 (IQR 31.3–56.3) for CG-estimated CLCR, 64.3 (IQR 49.8–81.7) for MDRD4-estimated CLCR and 49.3 (IQR 37.4–63.4) for MDRD6-estimated CLCR (respectively, p < 0.05, p < 0.001 and p = 0.44 compared with measured CLCR). Biases (±SD) for CG, MDRD4 and MDRD6 CLCR estimates were −3.6 (±22.2), 19.3 (±26.4) and 2.4 (±22.5) mL/min, respectively. When estimated CLCR values were assessed against the measured value, it was found that misclassification of renal impairment (absent/moderate/severe) occurred in 41 % of patients when using the CG, in 40 % when using the MDRD6, and in 45 % when using the MDRD4. The 30 % accuracies of the three formulae were 63 % for CG, 37 % for MDRD4 and 59 % for MDRD6.

Conclusion

In elderly hospitalized patients, CG and MDRD6 gave better predictions for measured CLCR than MDRD4, with no significant difference between them.

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. Maaravi Y, Bursztyn M, Hammerman-Rozenberg R, et al. Moderate renal failure at 70 years predicts mortality. QJM. 2006;99:97–102.

    Article  PubMed  CAS  Google Scholar 

  2. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    Article  PubMed  CAS  Google Scholar 

  3. Papaioannou A, Ray JG, Ferko NC, et al. Estimation of creatinine clearance in elderly persons in long-term care facilities. Am J Med. 2001;111:569–73.

    Article  PubMed  CAS  Google Scholar 

  4. Clase CM, Garg AX, Kiberd BA. Prevalence of low glomerular filtration rate in nondiabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III). J Am Soc Nephrol. 2002;13:1338–49.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Levey AS, Bosch JP, Lewis JB, et al. 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  PubMed  CAS  Google Scholar 

  7. Verhave JC, Fesler P, Ribstein J, et al. Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis. 2005;46(2):233–41.

    Article  PubMed  CAS  Google Scholar 

  8. Froissart M, Rossert J, Jacquot C, et al. Predictive performance of the modification of diet in renal disease and Cockcroft–Gault equations for estimating renal function. J Am Soc Nephrol. 2005;16:763–73.

    Article  PubMed  Google Scholar 

  9. Rigalleau V, Lasseur C, Perlemoine C, et al. Cockcroft–Gault formula is biased by body weight in diabetic patients with renal impairment. Metabolism. 2006;55(1):108–12.

    Article  PubMed  CAS  Google Scholar 

  10. Poggio ED, Nef PC, Wang X, et al. Performance of the Cockcroft–Gault and modification of diet in renal disease equations in estimating GFR in ill hospitalized patients. Am J Kidney Dis. 2005;46(2):242–52.

    Article  PubMed  Google Scholar 

  11. Seronie-Vivien S, Toullec S, Malard L, et al. Contribution of the MDRD equation and of cystatin C for renal function estimates in cancer patients. Med Oncol. 2006;23(1):63–73.

    Article  PubMed  CAS  Google Scholar 

  12. Van Den Noortgate NJ, Janssens WH, Delanghe JR, et al. Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old. J Am Geriatr Soc. 2002;50(7):1278–82.

    Article  Google Scholar 

  13. Lamb EJ, Webb MC, Simpson DE, et al. Estimation of glomerular filtration rate in older patients with chronic renal insufficiency: is the modification of diet in renal disease formula an improvement? J Am Geriatr Soc. 2003;51(7):1012–7.

    Article  PubMed  Google Scholar 

  14. Jabary NS, Martin D, Munoz MF, et al. Serum creatinine and creatinine clearance to estimate renal function in essential hypertension. Nefrologia. 2006;26(1):64–73.

    PubMed  CAS  Google Scholar 

  15. Laroche ML, Charmes JP, Marcheix A, et al. Estimation of glomerular filtration rate in the elderly: Cockcroft–Gault formula versus modification of diet in renal disease formula. Pharmacotherapy. 2006;26:1041–6.

    Article  PubMed  Google Scholar 

  16. Pedone C, Corsonello A, Incalzi RA, et al. Estimating renal function in older people: a comparison of three formulas. Age Ageing. 2006;35:121–6.

    Article  PubMed  Google Scholar 

  17. Corsonello A, Pedone C, Lattanzio F, et al. Association between glomerular filtration rate and adverse drug reactions in elderly hospitalized patients: the role of the estimating equation. Drugs Aging. 2011;28(5):379–90.

    Article  PubMed  Google Scholar 

  18. Péquignot R, Belmin J, Chauvelier S, et al. Renal function in older hospital patients is more accurately estimated using the Cockcroft–Gault formula than the modification diet in renal disease formula. J Am Geriatr Soc. 2009;57(9):1638–43.

    Article  PubMed  Google Scholar 

  19. Charlson M, Pompei P, Ales K, Mackenzie R. A new method of classifying prognostic comorbidity and longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  PubMed  CAS  Google Scholar 

  20. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.

    Article  PubMed  CAS  Google Scholar 

  21. Mühlberg W, Platt D. Age-dependent changes of the kidneys: pharmacological implications. Gerontology. 1999;45:243–53.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

  1. Service de Gériatrie, Hôpital Charles Foix et Université UPMC-Paris 6, 7 avenue de la Republique, 94200, Ivry-sur-Seine, France

    Sophie Chauvelier & Joel Belmin

  2. Service de Médecine et Réadaptation, Hôpitaux de Saint-Maurice, 94415, Saint-Maurice, France

    Renaud Péquignot

  3. Service Soins de Suite et Réadaptation, Centre Hospitalier de Versailles, 78000, Versailles, France

    Abdelfarouk Amzal

  4. Hôpital Broca, Université René Descartes-Paris V, 75013, Paris, France

    Olivier Hanon

Authors
  1. Sophie Chauvelier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renaud Péquignot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdelfarouk Amzal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Hanon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joel Belmin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel Belmin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chauvelier, S., Péquignot, R., Amzal, A. et al. Comparison between the Three Most Popular Formulae to Estimate Renal Function, in Subjects 75 Years of Age or Older. Drugs Aging 29, 885–890 (2012). https://doi.org/10.1007/s40266-012-0027-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-012-0027-y

Keywords

Search

Navigation