Clinical Value of Automatic Reporting of Estimated Glomerular Filtration Rate in Geriatrics

• Published in: Gerontology (Basel) Vol. 55; no. 3; pp. 288 - 295
• Main Authors: Kurtal, Hanife, Schwenger, Vedat, Azzaro, Marina, Abdollahnia, Nadja, Steinhagen-Thiessen, Elisabeth, Nieczaj, Rolf, Schulz, Ralf-Joachim
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2009; S. Karger AG
• Subjects: Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Body Mass Index; Clinical Laboratory Techniques - standards; Clinical Section; Comorbidity; Creatinine - blood; Development. Metamorphosis. Moult. Ageing; Drug dosages; Drug therapy; Female; Fundamental and applied biological sciences. Psychology; Geriatric Assessment; Glomerular Filtration Rate - physiology; Health risk assessment; Hospitalization; Humans; Kidney diseases; Logistic Models; Male; Multivariate Analysis; Older people; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Retrospective Studies; Sex Factors; Side effects; Statistics, Nonparametric; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Chronic kidney disease; Drug therapy; Elderly; Estimation of renal function; Human; Kidney disease; Drug; Senescence; Urinary system disease; Glomerular filtration; Renal function; Vertebrata; Mammalia; Renal failure
• ISSN: 0304-324X; 1423-0003
• DOI: 10.1159/000172982

Background: Geriatric patients frequently have impaired renal function. Multimorbidity leads to polypharmacy with high risk of adverse drug reactions. Objective: The aim was to evaluate the prevalence of renal impairment and risk of overdosing renally excreted drugs in hospitalized geriatric patients. Methods: In 221 patients aged ≥65 years, GFR was estimated by the MDRD, Cockcroft-Gault (CG) and lean body mass (LBM)-adjusted CG equations. Results: A reduced renal function (<60 ml/min/1.73 m 2 ) was found in 43% by MDRD, 61% by CG, and 71.9% by LBM-CG. The prevalence of severe impairment (<30 ml/min/1.73 m 2 ) was 3.3% based on MDRD, 5.4% on CG, and 13.6% on LBM-CG. At mean 10 medications were applied simultaneously. In patients with reduced eGFR, 52% of medications required dosage adjustment. Unfractionated heparins, ACE inhibitors, antibiotics, diuretics, and potassium were frequently used. Conclusions: For all limitations of formulaic GFR estimation in the elderly, routine assessment of renal function by reporting of eGFR helps to identify patients with chronic kidney disease and supports drug dosing. Implementation of routine reporting of eGFR is mandatory in standardized geriatric assessment.