Serum creatinine is an inadequate screening test for renal failure in elderly patients
Serum creatinine is an inadequate screening test for renal failure in elderly patients
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DOI：
10.1001/archinte.163.3.356
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发表时间：
2003-02-10
影响因子：
--
通讯作者：
Akbari, A
中科院分区：
文献类型：
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作者：
Swedko, P;Clark, HD;Akbari, A
背景：血清肌酐是最常用的肾功能衰竭筛查试验。我们假设血清肌酐会低估老年人肾功能衰竭的程度，因为他们的肌肉质量减少。如果是这样的话，这将导致认识不足，从而次优的照顾严重renal failure.Methods：我们进行了一项回顾性的病历审查，所有患者65岁或以上的门诊学术家庭医学实践。肾小球滤过率采用Cockcroft和Gault公式计算，并用于评价血清肌酐检测肾功能衰竭的检测特征。结果：我们筛选了1510例患者，其中854例（56.6%）符合纳入标准。28.9%的患者出现肾功能衰竭（肾小球滤过率，小于或等于50 mL/min），6.4%的患者出现严重肾功能衰竭（Cockcroft和Gault公式肾小球滤过率，小于或等于30 mL/min）。血清肌酐水平大于1。7 mg/dL（> 150 mumol/L）检测肾功能衰竭的敏感性为12.6%，特异性为99.9%。对于严重肾功能衰竭的检测，敏感性为45.5%，特异性为99.1%。55例重度肾衰竭患者中仅15例（27.3%）转诊至肾病科医生。此外，34（85%）的40名非严重肾功能衰竭患者的代谢并发症与肾功能不全相关的不完全评估dysfunction.Conclusion：血清肌酐是一个贫穷的筛选试验，在老年患者肾功能衰竭，导致显着的调查和认识不足，在这一人群中的肾功能衰竭。
Background: Serum creatinine is the most commonly used screening test for renal failure. We hypothesized that serum creatinine would underestimate the degree of renal failure in elderly people because they have a reduced muscle mass. if so, this would lead to underrecognition and thus suboptimal care of patients with severe renal failure.Methods: We conducted a retrospective medical record review of all patients 65 years or older in an outpatient academic family medicine practice. The glomerular filtration rate was calculated using the Cockcroft and Gault formula and was used to evaluate the testing characteristics of serum creatinine for the detection of renal failure.Results: We screened 1510 patients, 854 (56.6%) of whom met the inclusion criteria. Renal failure ( glomerular filtration rate, less than or equal to50 mL/min) was present in 28.9% of the patients, and severe renal failure (Cockcroft and Gault formula glomerular filtration rate, less than or equal to30 mL/min) was present in 6.4%. A serum creatinine level of greater than 1. 7 mg/dL (> 150 mumol/L) had a sensitivity of 12.6% and a specificity of 99.9% for the detection of renal failure. For the detection of severe renal failure, the sensitivity was 45.5%, with a 99.1% specificity. Only 15 (27.3%) of the 55 patients with severe renal failure were referred to a nephrologist. Moreover, 34 (85%) of the 40 non-referred patients with severe renal failure were incompletely evaluated regarding the metabolic complications associated with kidney dysfunction.Conclusion: Serum creatinine is a poor screening test for renal failure in elderly patients, leading to marked under investigation and underrecognition of renal failure in this population.