Serum Creatinine Is an Inadequate Screening Test for Renal Failure in Elderly Patients

Swedko, Peter J.; Clark, Heather D.; Paramsothy, Koushi; Akbari, Ayub

doi:10.1001/archinte.163.3.356

Cited by 279 publications

(195 citation statements)

References 32 publications

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“…This explains the high inter-individual variability of SCr, which precludes a reliable estimation of kidney function from a single creatinine measurement without additional patient data (12). As a result, SCr has poor sensitivity for renal failure or mild renal dysfunction, particularly in children, malnourished or elderly patients and severely ill patients, with consequent under-recognition of renal impairment (14,15).…”

Section: Creatininementioning

confidence: 99%

Monitoring renal function: measured and estimated glomerular filtration rates - a review

Salgado

Neves

Bastos

et al. 2010

Braz J Med Biol Res

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Section: Creatininementioning

confidence: 99%

Monitoring renal function: measured and estimated glomerular filtration rates - a review

Salgado

Neves

Bastos

et al. 2010

Braz J Med Biol Res

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“…A few studies have demonstrated that primary care physicians relying on serum creatinine fail to diagnose CKD in elderly patients, 16,17 and that diagnostic rates can be improved by providing estimated GFR (eGFR) based on either the CG or MDRD equations. [17][18][19] Whether such recognition leads to changes in physician practice which may slow the progression of chronic kidney disease is unclear.…”

Section: Introductionmentioning

confidence: 99%

Recognition and Management of Chronic Kidney Disease in an Elderly Ambulatory Population

et al. 2008

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BACKGROUND: Chronic kidney disease (CKD) is a growing problem among the elderly. Early detection is considered essential to ensure proper treatment and to avoid drug toxicity, but detection is challenging because elderly patients with CKD often have normal serum creatinine levels. We hypothesized that most cases of CKD in the elderly would go undetected, resulting in inappropriate prescribing. OBJECTIVE:To determine whether recognition of CKD is associated with more appropriate treatment DESIGN: Retrospective chart review PARTICIPANTS: All patients aged ≥65 years with a measured serum creatinine in the past 3 years at 2 inner city academic health centers.MEASUREMENTS: Estimated glomerular filtration rate (eGFR) calculated using the Modified Diet in Renal Disease equation, and for patients with eGFR<60, documentation of CKD by the provider, diagnostic testing, nephrology referral and prescription of appropriate or contraindicated medications. RESULTS:Of 814 patients with sufficient information to estimate eGFR, 192 (33%) had moderate (eGFR< 60 mL/min) and 5% had severe (eGFR<30 mL/min) CKD. Providers identified 38% of moderate and 87% of severe CKD. Compared to patients without recognized CKD, recognized patients were more likely to receive an ACE/ARB (80% vs 61%, p=.001), a nephrology referral (58% vs 2%, p<.0001), or urine testing (75% vs 47%, p<.0001), and less likely to receive contraindicated medications (26% vs 40%, p=.013). CONCLUSIONS:Physicians frequently fail to diagnose CKD in the elderly, leading to inappropriate treatment. Efforts should focus on helping physicians better identify patients with low GFR.

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“…The median duration of hospitalization was 15 days (13)(14)(15)(16)(17)(18)(19)(20)(21). Patients who died at baseline had higher values of all biochemical markers, leukocytes and haemoglobin levels.…”

Section: Resultsmentioning

confidence: 99%

Prognostic significance of Blood Urea Nitrogen in comparison to Creatinine levels in mortality assessment of patients at admission with Acute Coronary Syndrome in Shivamogga district, Karnataka

2020

IJCBR

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Introduction and Objectives: Several studies have hypothesized the relation of Blood Urea Nitrogen (BUN) and serum Creatinine level with the severity of coronary artery disease. The basis of this study is to show the prognostic significance of BUN and serum Creatinine levels at admission for assessing the risk of mortality in patients with acute coronary syndromes (ACS). This study also undertakes the comparative prognostic significance of BUN over serum creatinine as an indicator of risk of mortality in patients with ACS. Materials and Methods & Results:This was a prospective study of all patients admitted with suspected (n=1019) and retrospectively confirmed (n=65) Myocardial Infarction (MI) or Unstable Angina. The Receiver-operating characteristic curve analysis established that the area under the curve for BUN was higher than that of Creatinine 0.71 (95% CL 0.65 to 0.78) and 0.63 (95% CL 0.59 to 0.66), respectively (p=0.005). The threshold level was 8.6mmol/L for BUN and 110µmol/L for Creatinine. Sensitivity was 61% and 56% for threshold levels of BUN and Creatinine, and specificity was 84% and 78%, respectively. It is seen only an increase of BUN and a combination of increased BUN and Creatinine levels, as risk factors of mortality with ACS. Isolated increase in creatinine levels was not found to be significant. Separate inclusion of BUN and Creatinine as continuous variables in the regression model showed that both were associated with the risk of mortality. Odds Ratio (OR) 1.18 (95% CL 1.12 to 1.25) and 1.08 (95% CL 1.011 to 1.019) per unit increase (R 2 =12.5 and 8.1% respectively). When both were simultaneously included, only the increased BUN level was persistent with the prognosis of ACS: OR after multivariate adjustment 1.14 (95% CL 1.04 to 1.18). Conclusion: An increased level of BUN is a more significant prognostic marker of mortality assessment at admission in ACS than that of serum Creatinine.

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Serum Creatinine Is an Inadequate Screening Test for Renal Failure in Elderly Patients

Abstract: Serum creatinine is a poor screening test for renal failure in elderly patients, leading to marked underinvestigation and underrecognition of renal failure in this population.

Cited by 279 publications

References 32 publications

Monitoring renal function: measured and estimated glomerular filtration rates - a review

Monitoring renal function: measured and estimated glomerular filtration rates - a review

Recognition and Management of Chronic Kidney Disease in an Elderly Ambulatory Population

Prognostic significance of Blood Urea Nitrogen in comparison to Creatinine levels in mortality assessment of patients at admission with Acute Coronary Syndrome in Shivamogga district, Karnataka

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