Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-28T03:19:00.803Z Has data issue: false hasContentIssue false
  • English
  • Français

Measuring renal function in old age

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  01 November 2008

Sanghamitra Chakrabarti  and
Indrajit Chattopadhyay
Sanghamitra Chakrabarti
Affiliation:
Glan Clwyd Hospital, Rhyl, Wales
Indrajit Chattopadhyay*
Affiliation:
Glan Clwyd Hospital, Rhyl, Wales
*
Address for correspondence: I Chattopadhyay, Consultant Physician, Department of Health Care of the Elderly, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ, UK. Email: indrajit.chatterjee@cd-tr.wales.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Extract

Accurate assessment of renal function is vital, especially in older individuals, as this is the population in which the greatest burden of chronic kidney disease (CKD) occurs. With ageing, the kidneys undergo a multitude of structural and functional changes. The age-related changes in the kidneys may be further complicated by concurrent pre-renal, renal and post-renal factors common in old age, such as hypertensive glomerulosclerosis, diabetic nephropathy, congestive cardiac failure, renovascular atheroma, urinary outflow obstruction, urinary tract infections, renal stones and drug-induced nephrotoxicity. Structurally, there is a progressive loss of predominantly cortical renal mass, a decrease in the number of glomeruli, an increase in the proportion of sclerotic glomeruli, tubulo-interstitial changes resulting in fibrosis and atrophy, arteriosclerotic vascular changes and a reduction in renal blood flow. Excretory and reabsorptive capacities of the renal tubules may also decline with ageing. Functionally, although there may be a decline in the glomerular filtration rate (GFR) resulting primarily from a reduction in the number of functioning nephrons, this decline may not be universal. Up to a third of elderly people may not demonstrate a decline in GFR with ageing, whilst in some individuals GFR may actually increase with age.

Type
Clinical gerontology
Information
Reviews in Clinical Gerontology , Volume 18 , Issue 4 , November 2008 , pp. 257 - 267
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Choudhury, D, Raj, DSC, Levi, M. Effects of aging on renal function and disease. In: Brenner, BM (editor), The Kidney. Philadelphia: Saunders, 2004; 2305–41.Google Scholar
2Lindeman, RD, Tobin, J, Shock, NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985; 33: 278–85.Google Scholar
3Zhang, QL, Rothenbacher, D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 2008; 8: 117.Google Scholar
4Roderick, PJ, Atkins, RJ, Smeeth, L et al. Detecting chronic kidney disease in older people; what are the implications? Age Ageing 2008; 37: 179–86.Google Scholar
5National Kidney Foundation. Kidney Disease Outcomes Quality Initiative: Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002; 39 (suppl 1): S1–266.Google Scholar
6Go, AS, Chertow, GM, Fan, D, McCulloch, CE, Hsu, CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalisation. N Engl J Med 2004; 351: 1296–305.Google Scholar
7National Institute for Health and Clinical Excellence. Chronic Kidney Disease: Early identification and management of chronic kidney disease in adults in primary and secondary care. 2008 (clinical guideline 73): 1–36.Google Scholar
8Landray, MJ, Haynes, RJ. Commentary: Controversies in NICE guidance on chronic kidney disease. BMJ 2008; 337: 815–16.Google Scholar
9Department of Health. National Service Framework for Renal Services. Part Two: Chronic Kidney Disease, Acute Renal Failure and End of Life Care. 2005; Obtainable from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH. (accessed 8th February 2009).Google Scholar
10Silkensen, JR, Kasiske, BL. Laboratory assessment of kidney disease: Clearance, urinalysis, and kidney biopsy. In: Brenner, BM (editor), The Kidney. Philadelphia: Saunders, 2004; 1107–50.Google Scholar
11Florijn, KW, Barendregt, JN, Lentjes, EG et al. Glomerular filtration rate measurement by ‘single-shot’ injection of inulin. Kidney Int 1994; 46: 252–59.Google Scholar
12Bennett, WM, Porter, GA. Endogenous creatinine clearance as a clinical measure of glomerular filtration rate. BMJ 1971; 4: 84–86.Google Scholar
13Ross, EA, Wilkinson, A, Hawkins, RA, Danovitch, GM. The plasma creatinine concentration is not an accurate reflection of the glomerular filtration rate in stable transplant patients receiving cyclosporine. Am J Kidney Dis 1987; 10: 113–17.Google Scholar
14Brochner-Mortensen, J, Rodbro, P. Selection of routine method for determination of glomerular filtration rate in adult patients. Scand J Clin Lab Invest 1976; 36: 35–43.Google Scholar
15Rehling, M, Moller, ML, Thamdrup, B, Lund, JO, Trap-Jensen, J. Simultaneous measurement of renal clearance and plasma clearance of 99mTc-labelled diethylenetriaminepenta-acetate, 51Cr-labelled ethylenediaminetetra-acetate and inulin in man. Clin Sci 1984; 66: 613–19.Google Scholar
16Moore, AE, Park-Holohan, SJ, Blake, GM, Fogelman, I. Conventional measurements of GFR using 51Cr-EDTA overestimate true renal clearance by 10 per cent. Eur J Nucl Med Mol Imaging 2003; 30: 4–8.Google Scholar
17Russell, CD, Bischoff, PG, Rowell, KL et al. Quality control of Tc-99m DTPA for measurement of glomerular filtration: Concise communication. J Nucl Med 1983; 24: 722–27.Google Scholar
18Goates, JJ, Morton, KA, Whooten, WW et al. Comparison of methods for calculating glomerular filtration rate: Technetium-99m-DTPA scintigraphic analysis, protein-free and whole-plasma clearance of technetium-99m-DTPA and iodine-125-iothalamate clearance. J Nucl Med 1990; 31: 424–29.Google Scholar
19O'Reilly, PH, Jones, DA, Farah, NB. Measurement of the plasma clearance of urographic contrast media for the determination of glomerular filtration rate. J Urol 1988; 139: 9–11.CrossRefGoogle ScholarPubMed
20Baracskay, D, Jarjoura, D, Cugino, A, Blend, D, Rutecki, GW, Whittier, FC. Geriatric renal function: estimating glomerular filtration in an ambulatory elderly population. Clin Nephrol 1997; 47: 222–28.Google Scholar
21Sanaka, M, Takano, K, Shimakura, K, Koike, Y, Mineshita, S. Serum albumin for estimating creatinine clearance in elderly with muscle atrophy. Nephron 1996; 73: 137–44.Google Scholar
22Bjornsson, TD, Cocchetto, DM, McGowan, FX, Verghese, CP, Sedor, F. Nomogram for estimating creatinine clearance. Clin Pharmacokinet 1983; 8: 365–69.Google Scholar
23Hull, JH, Hak, LJ, Koch, GC, Wargin, WA, Chi, SL, Mattocks, AM. Influence of range of renal function and liver disease on predictability of creatinine clearance. Clin Pharmacol Ther 1981; 29: 516–21.Google Scholar
24Jelliffe, RW. Creatinine clearance: bedside estimate. Ann Intern Med 1973; 79: 604–5.Google Scholar
25Cockcroft, DW, Gault, MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.Google Scholar
26Levey, AS, Bosch, JP, Lewis, JB, Greene, T, Rogers, N, Roth, D. 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.Google Scholar
27Levey, AS, Greene, T, Kusek, J, Beck, G. A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol 2000; 11: 155A.Google Scholar
28Rule, AD, Larson, TS, Bergstralh, EJ, Slezak, JM, Jacobsen, SJ, Cosio, FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004; 141: 929–37.Google Scholar
29Poggio, ED, Wang, X, Greene, T, Van Lente, F, Hall, PM. Performance of the Modification of Diet in Renal Disease and Cockcroft-Gault equations in the estimation of GFR in health and chronic kidney disease. J Am Soc Nephrol 2005; 16: 459–66.Google Scholar
30Cirillo, M, Anastasio, P, De Santo, NG. Relationship of gender, age, and body mass index errors in predicted kidney function. Nephrol Dial Transplant 2005; 20: 1791–98.Google Scholar
31Froissart, M, Rossert, J, Jacquot, C, Paillard, M, Houillier, P. 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.Google Scholar
32UK Renal Association Clinical Practice Guidelines: Clinical Practice Guidelines for the Care of Patients with Chronic Kidney Disease. 2007; obtainable from: http://www.renal.org/guidelines. (accessed 14th February 2009).Google Scholar
33Maaravi, Y, Bursztyn, M, Hammerman-Rozenberg, R, Cohen, A, Stessman, J. Moderate renal insufficiency at 70 years predicts mortality. QJM 2006; 99: 97–102.Google Scholar
34Brugts, JJ, Knetsch, AM, Mattace-Raso, FU, Hofman, A, Witteman, JC. Renal function and risk of myocardial infarction in an elderly population: the Rotterdam Study. Arch Intern Med 2005; 165: 2659–65.Google Scholar
35Lewis, J, Greene, T, Appel, L et al. A comparison of iothalamate-GFR and serum creatinine based outcomes: acceleration in the rate of GFR decline in the African American study of kidney disease and hypertension. J Am Soc Nephrol 2004; 15: 3175–83.CrossRefGoogle ScholarPubMed
36Wang, X, Lewis, J, Appel, L et al. Validation of creatinine based estimates of GFR when evaluating risk factors in longitudinal studies of kidney disease. J Am Soc Nephrol 2006; 17: 2900–9.Google Scholar
37Lamb, EJ, Tomson, CRV, Roderick, PJ. Estimating kidney function in adults using formulae. Ann Clin Biochem 2005; 42: 321–45.Google Scholar
38Coresh, J, Stevens, LA. Kidney function estimating equations: where do we stand? Curr Opin Nephrol Hypertens 2006; 15: 276–84.Google Scholar
39Kuan, Y, Hossain, M, Surman, J, El Nahas, AM, Haylor, J. GFR prediction using the MDRD and Cockcroft and Gault equations in patients with end-stage renal disease. Nephrol Dial Transplant 2005; 20: 2394–401.Google Scholar
40White, CA, Huang, D, Akbari, A, Garland, J, Knoll, GA. Performance of creatinine-based estimates of GFR in kidney transplant recipients: a systematic review. Am J Kidney Dis 2008; 51: 1005–15.Google Scholar
41Fontsere, N, Salinas, I, Bonal, J et al. Are prediction equations for glomerular filtration rate useful for long term monitoring of type 2 diabetic patients? Nephrol Dial Transplant 2006; 21: 2152–58.Google Scholar
42Rossing, P, Rossing, K, Gaede, P, Pedersen, O, Parving, HH. Monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy. Diabetes Care 2006; 29: 1024–30.Google Scholar
43Mahajan, S, Mukhiya, GK, Singh, R et al. Assessing glomerular filtration rate in healthy adults: A comparison of various prediction equations. J Nephrol 2005; 18: 257–61.Google Scholar
44Myers, GL, Miller, WG, Coresh, J et al. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 2006; 52: 5–18.Google Scholar
45Levey, AS, Coresh, J, Greene, T et al. Using standardized serum creatinine values in the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247–54.Google Scholar
46Department of Health. Estimated Glomerular Filtration Rate (eGFR) 2006; obtainable from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4133024. (accessed 24th March 2009).Google Scholar
47Lamb, EJ, Webb, MC, O'Riordan, SE. Using the modification of diet in renal disease (MDRD) and Cockcroft and Gault equations to estimate glomerular filtration rate (GFR) in older people. Age Ageing 2007; 36: 689–92.Google Scholar
48Hallan, S, Astor, B, Lydersen, S. Estimating glomerular filtration rate in the general population: the second Health Survey of Nord-Trondelag (HUNT II). Nephrol Dial Transplant 2006; 21: 1525–33.Google Scholar
49Wieczorowska-Tobis, K, Niemir, ZI, Guzik, P, Breborowicz, A, Oreopoulos, DG. Difference in estimated GFR with two different formulas in elderly individuals. Int Urol Nephrol 2006; 38: 381–85.Google Scholar
50Rimon, E, Kagansky, N, Cojocaru, L, Gindin, J, Schattner, A, Levy, S. Can creatinine clearance be accurately predicted by formulae in octogenarian in-patients? QJM 2004; 97: 281–87.Google Scholar
51Van Den Noortgate, NJ, Janssens, WH, Afschrift, MB, Lameire, NH. Renal function in the oldest-old on an acute geriatric ward. Int Urol Nephrol 2001; 32: 531–37.Google Scholar
52Gouin-Thibault, I, Pautas, E, Mahe, I et al. Is Modification of Diet in Renal Disease formula similar to Cockcroft-Gault formula to assess renal function in elderly hospitalized patients treated with low-molecular-weight heparin? J Gerontol A Biol Sci Med Sci 2007; 62: 1300–5.Google Scholar
53Gill, J, Malyuk, R, Djurdjev, O, Levin, A. Use of GFR equations to adjust drug doses in an elderly multi-ethnic group – a cautionary tale. Nephrol Dial Transplant 2007; 22: 2894–99.Google Scholar
54Melloni, C, Peterson, ED, Chen, AY et al. Cockcroft-Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes. J Am Coll Cardiol 2008; 51: 991–6.Google Scholar
55Pedone, C, Corsonello, A, Incalzi, RA. Estimating renal function in older people: a comparison of three formulas. Age Ageing 2006; 35: 121–6.Google Scholar
56Launay-Vacher, V, Chatelut, E, Lichtman, SM, Wildiers, H, Steer, C, Aapro, M. International Society of Geriatric Oncology. Renal insufficiency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations. Ann Oncol 2007; 18: 1314–21.CrossRefGoogle ScholarPubMed
57Davenport, A, Stevens, P. Clinical Practice Guidelines. Module 5: Acute Kidney Injury. UK Renal Association, 4th edition, 2008; obtainable from www.renal.org/guidelines (accessed 9th February 2009).Google Scholar
58Prigent, A. Monitoring renal function and limitations of renal function tests. Semin Nucl Med 2008; 38: 32–46.Google Scholar
59Simonsen, O, Gribb, A, Thysell, H. The blood serum concentration of cystatin C (gamma trace) as a measure of glomerular filtration rate. Scand J Clin Lab Invest 1985; 45: 97–101.Google Scholar
60Dharnidharka, VR, Kwon, C, Stevens, G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis. Am J Kidney Dis 2002; 40: 221–26.CrossRefGoogle ScholarPubMed
61Laterza, OF, Price, CP, Scott, MG. Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem 2002; 48: 699–707.Google Scholar
62Wasen, E, Suominen, P, Isoaho, R et al. Serum cystatin C as a marker of kidney dysfunction in an elderly population. Clin Chem 2002; 48: 1138–40.Google Scholar
63Van Den Noortgate, NJ, Janssens, WH, Delanghe, JR, Afschrift, MB, Lameire, NH. Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old old. J Am Geriatr Soc 2002; 50: 1278–82.Google Scholar
64Hojs, R, Bevc, S, Antolinc, B, Gorenjak, M, Puklavec, L. Serum cystatin C as an endogenous marker of renal function in the elderly. Int J Clin Pharmacol Res 2004; 24: 49–54.Google Scholar
65Wasen, E, Isoaho, R, Mattila, K, Vahlberg, T, Kivela, SL, Irjala, K. Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum cystatin C. J Intern Med 2004; 256: 70–8.Google Scholar
66Tian, S, Kusano, E, Ohara, T et al. Cystatin C measurement and its practical use in patients with various renal diseases. Clin Nephrol 1997; 48: 104–8.Google Scholar
67Madero, M, Sarnak, MJ, Stevens, LA. Serum cystatin C as a marker of glomerular filtration rate. Curr Opin Nephrol Hypertens 2006; 15: 610–16.Google Scholar
68Keevil, BG, Kilpatrick, ES, Nicholas, SP, Maylor, PW. Biological variation of cystatin C: implications for the assessment of glomerular filtration rate. Clin Chem 1998; 44: 1535–39.Google Scholar
69Knight, EL, Verhave, JC, Spiegelman, D et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 2004; 65: 1416–21.Google Scholar
70Herget-Rosenthal, S, Bokenkamp, A, Hofmann, W. How to estimate GFR – serum creatinine, serum cystatin C or equations? Clin Biochem 2007; 40: 153–61.Google Scholar
71Coll, E, Botey, A, Alvarez, L et al. Serum cystatin C as a new marker for non-invasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000; 36: 29–34.Google Scholar
72Mussap, M, Dalla Vestra, M, Fioretto, P et al. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney Int 2002; 61: 1453–61.Google Scholar
73Perkins, BA, Nelson, RG, Ostrander, BE et al. Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: results of a 4-year follow-up study. J Am Soc Nephrol 2005; 16: 1404–12.Google Scholar
74Stevens, LA, Coresh, J, Schmid, CH et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008; 51: 395–406.Google Scholar
75Hojs, R, Bevc, S, Ekart, R, Gorenjak, M, Puklavec, L. Serum cystatin C-based equation compared to serum creatinine-based equations for estimation of glomerular filtration rate in patients with chronic kidney disease. Clin Nephrol 2008; 70: 10–17.Google Scholar
76Tidman, M, Sjostrom, P, Jones, I. A comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant 2008; 23: 154–60.Google Scholar
77Jonsson, AS, Flodin, M, Hansson, LO, Larsson, A. Estimated glomerular filtration rate (eGFRCystC) from serum cystatin C shows strong agreement with iohexol clearance in patients with low GFR. Scand J Clin Lab Invest 2007; 67: 801–9.Google Scholar
78Rule, AD, Bergstralh, EJ, Slezak, JM, Bergert, J, Larson, TS. Glomerular filtration rate estimated by cystatin C among different clinical presentations. Kidney Int 2006; 69: 399–405.Google Scholar
79White, C, Akbari, A, Hussain, N et al. Chronic kidney disease stage in renal transplantation-classification using cystatin C and creatinine based equations. Nephrol Dial Transplant 2007; 22: 3013–20.Google Scholar
80Delanaye, P, Pieroni, L, Abshoff, C et al. Analytical study of three cystatin C assays and their impact on cystatin C-based GFR-prediction equations. Clinica Chimica Acta 2008; 398: 118–24.Google Scholar
81Shea, PH, Maher, JF, Horak, E. Prediction of glomerular filtration rate by serum creatinine and beta 2-microglobulin. Nephron 1981; 29: 30–35.Google Scholar
82Tonelli, M, Sacks, F, Pfeffer, M, Jhangri, GS, Curhan, G. Cholesterol and Recurrent Events (CARE) Trial Investigators. Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int 2005; 68: 237–45.CrossRefGoogle Scholar
83Shikano, M, Sobajima, H, Yoshikawa, H et al. Usefulness of a highly sensitive urinary and serum IL-6 assay in patients with diabetic nephropathy. Nephron 2000; 85: 81–85.Google Scholar