Screening for renal disease using serum creatinine: who are we missing?

Duncan, Lynda; Heathcote, J. G.; Djurdjev, Ognjenka; Levin, Adeera

doi:10.1093/ndt/16.5.1042

Cited by 226 publications

(148 citation statements)

References 16 publications

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“…SCr concentration is the most widely used method of assessing renal function; however, in the present study SCr concentration method misplaced (108) 11.6% patients with impaired function. Our study is in harmony with Duncan et al [8] study reported that (13.9%) patients had misplaced with SCr concentration method. Yet another Indian study also forwarded similar results [11].…”

Section: Discussionsupporting

confidence: 91%

“…Despite the fact that SCr alone may not be well correlated with true GFR [7], many clinicians continue to rely solely on SCr as a measure of renal function and interpret a normal SCr as indicating normal renal function. However, many patients with impaired kidney function are failing to notice when relying on SCr alone [8]. But how many patients with impaired kidney function are missed when relying on SCr alone?…”

Section: Introductionmentioning

confidence: 99%

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Underestimation of Impaired Kidney Function with Serum Creatinine

2010

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Serum creatinine (SCr) levels are frequently used as a screening test to assess impaired renal function; however, patients can have significantly decreased glomerular filtration rate (GFR) with normal SCr values and making the recognition of kidney dysfunction more difficult. Hence, this study was designed to determine the extent of misclassification of the patients who have significantly reduced GFR as calculated by reexpressed four variable modification of diet in renal disease (MDRD) equation but, normal range of SCr. The study included 1040 in and out patients referred by physicians for serum creatinine measurement. When an exclusion criterion was applied 928 patients were qualified for the study. SCr was measured in 928 patients by a Roche kinetic compensated Jaffe's assay. GFR was calculated using reexpressed four variable MDRD study equation. Of the 928 patients 270 (29.1%) had renal dysfunction on the basis of eGFR (\60 ml/min/1.73 m 2 ). However, with SCr only 162 (17.5%) patients had abnormal renal function ([1.5 mg/dl) and SCr values misrepresented (108) 11.6% patients with impaired kidney function. In addition, more females, about 15% were failed to detect by SCr method in contrast to males of 9%. This study documented that, a large proportion of patients with impaired renal function are not diagnosed if clinicians rely solely on normal SCr as evidence of normal renal function. Inclusion of eGFR calculated by re-expressed 4 variable MDRD equation may facilitates the early identification and intervention of patients with renal impairment.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Underestimation of Impaired Kidney Function with Serum Creatinine

2010

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“…GFR in the 30-to 80-ml/min range in older people is often accompanied by a serum creatinine within the laboratory normal range (37,41) and may go unrecognized, uninvestigated, and unreferred (41). Only a minority of patients with an elevated creatinine are referred to nephrologists (55,56).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Low Glomerular Filtration Rate in Nondiabetic Americans

Clase¹,

Garg

Kiberd

2002

Journal of the American Society of Nephrology

196

111

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Abstract. End-stage renal disease is an important and costly health problem. Strategies for its prevention are urgently needed. Knowledge of the population-based prevalence of renal insufficiency in nondiabetic adults would inform such strategies. Black and white nondiabetic adult participants in the Third National Health and Nutrition Examination Survey were analyzed. The analysis was stratified by age, gender, and race, and four clinically applicable methods were used to assess renal function. There were 13,251 complete records for analysis. By the Modification of Diet in Renal Diseases (MDRD) GFR (GFR) prediction Equation 7, 58% (95% confidence interval [CI], 56 to 60%) of the total adult nondiabetic black and white US population had MDRD GFR below 80 ml/min per 1. . By the Cockcroft-Gault formula, the equivalent figures were 39% (95% CI, 37 to 41%), 14% (95% CI, 12% -16%), and 0.81% (95% CI, 0.46 to 1.2%), respectively. The findings of an unexpectedly high prevalence of low clearance and the increased prevalence of low clearance with age were consistent across the four clearance estimation methods used and for each race-sex stratum. The absolute magnitude of the prevalence of low clearance was, however, dependent on the clearance method used. Assessed by estimation from serum creatinine, low clearance may be very common, particularly with advancing age. The prognosis (in terms of risk for progression and end-stage renal disease) of low clearance in unreferred populations may differ from that in referred populations and requires further study.The incidence of end-stage renal disease (ESRD) increases annually in the United States and is projected to continue to increase over the next decade (1). ESRD is associated with increased morbidity (1) and with mortality comparable with that of common malignancies (2). Improving outcomes for patients at risk of ESRD is an important mandate for primary care practitioners, generalists, and nephrologists. There is compelling evidence that BP control and angiotensin-converting enzyme (ACE) inhibitor use reduce the rate of progression of chronic renal insufficiency (CRI) (3-7) and should reduce the number of patients with ESRD. Referral to a nephrologist several months before the initiation of dialysis is associated with lower morbidity on dialysis and improved outcomes (8 -11) but is underutilized (12).Strategies to enhance implementation of these approaches are needed. Guidelines for the appropriate management and referral of patients with CRI have been developed in Canada (13), and they are under development in the US (the Kidney Disease Outcomes Quality Initiative [K/DOQI]) (14). To be feasible and effective, recommendations about suitable strategies must take the prevalence of renal insufficiency into account. The population prevalence for elevated creatinine (Ͼ1.5 mg/dl in men; Ͼ1.4 mg/dl in women) has been estimated at 8.0% of men and 8.9% of women by Culleton et al. (15) in Framingham Heart Study participants. Nissenson et al. (16), using data from a large US health...

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“…Band et al 23 reported that creatinine clearance in 40% of patients was lower than 60 mL/min, despite a serum creatinine level of 1.5 mg/dL or lower. Similarly, Duncan et al 24 noted that creatinine clearance in more than 15% of patients was lower than 50 mL/min when they had normal serum creatinine levels. In our study, the creatinine clearance of 23 (44%) of 52 patients with creatinine levels of 1.5 mg/dL and lower was lower than 60 mL/ min.…”

Section: Discussionmentioning

confidence: 89%

“…In the (20)(21)(22)(23)(24)(25)(26)(27) 0.56 dBP = diastolic blood pressure; RR = respiratory rate; sBP = systolic blood pressure; NAC = N-acetylcysteine. Data are reported as n (%) unless otherwise noted.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Short‐term Infusion Regimens of N‐Acetylcysteine Plus Intravenous Fluids, Sodium Bicarbonate Plus Intravenous Fluids, and Intravenous Fluids Alone for Prevention of Contrast‐induced Nephropathy in the Emergency Department

Kama

Yılmaz

Yaka

et al. 2014

Academic Emergency Medicine

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BackgroundThere is no evidence regarding the several short‐term prophylaxis protocols for contrast‐induced nephropathy (CIN) that may be most feasibly convenient in emergency settings.ObjectivesThe purpose of this study was to compare the efficacies of short‐term CIN prophylaxis protocols of normal saline, N‐acetylcysteine (NAC) plus saline, and sodium bicarbonate plus saline in emergency department (ED) patients at moderate or high risk of CIN after receiving intravenous (IV) contrast agent.MethodsThis single‐center, randomized, nonblinded clinical trial was conducted in the ED with adult patients requiring contrast‐enhanced computed tomography (CT). Patients with moderate to high risk of CIN according to the Mehran risk score, who consented to participate, were eligible. Patients with continuous renal replacement therapy or who reported contrast allergy were excluded. Enrolled patients were randomly assigned to receive 150 mg/kg NAC in 1000 mL of 0.9% sodium chloride (NaCl), 150 mEq of sodium bicarbonate in 1000 mL of 0.9% NaCl, or 1000 mL of IV saline infusion, all given at 350 mL/hr for 3 hours. All of the patients were administered less than 100 mL of nonionic, low‐osmolality contrast agent. The primary outcome of CIN was defined as a 25% increase or a greater than 0.5 mg/dL increase in the serum creatinine level 48 to 72 hours later compared with the baseline measurement.ResultsA total of 107 patients were randomized to NAC (n = 36), sodium bicarbonate (n = 36), and saline prophylaxis (n = 35). The mean age of the patients was 71 years (95% confidence interval [CI] = 65 to 77 years), and 58 (54.2%) were male. The groups were similar regarding baseline characteristics and nephropathy risks. Of the 16 (14.9%) patients who eventually developed CIN, seven (19.4%) were in the NAC plus saline group, four (11.1%) were in the sodium bicarbonate plus saline group, and five (14.2%) were in the saline group. There were no significant differences between the groups in terms of the prevention of CIN (p = 0.60).ConclusionsNone of the short‐term protocols with normal saline, NAC, or sodium bicarbonate was superior in ED patients requiring contrast‐enhanced CT who had a moderate or high risk of CIN.

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Screening for renal disease using serum creatinine: who are we missing?

Cited by 226 publications

References 16 publications

Underestimation of Impaired Kidney Function with Serum Creatinine

Underestimation of Impaired Kidney Function with Serum Creatinine

Prevalence of Low Glomerular Filtration Rate in Nondiabetic Americans

Comparison of Short‐term Infusion Regimens of N‐Acetylcysteine Plus Intravenous Fluids, Sodium Bicarbonate Plus Intravenous Fluids, and Intravenous Fluids Alone for Prevention of Contrast‐induced Nephropathy in the Emergency Department

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