The study by Carnevale et al compared the different methods used to measure estimated
glomerular filtration rate (eGFR) with the estimated total skeletal muscle mass (eTSMM)
and highlighted the high degree of variability.
1
The decline in muscle mass or sarcopenia that occurs with aging renders the value
of serum creatinine as a poor estimate of eGFR, especially in the frail old, a fact
demonstrated decades ago.
2
In particular, the modification of diet in renal disease (MDRD) study included only
a limited number of older adults, as acknowledged by the authors, in a comparison
of the MDRD formula with the Cockcroft-Gault (C-G) formula and the Chronic Kidney
Disease Epidemiology Collaboration (CKD-EPI) equations; the lack of concurrence or
divergence of eGFR values while using these formulae poses limitations when they are
applied specifically in older adults.
3
,4
More recently, a cross-sectional study (by Selistre et al) involving adults aged
over 65 years with chronic kidney disease (CKD) demonstrated that none of 4 plasma
creatinine-based equations to estimate GFR offered clinically significant differences
in terms of accuracy, with there being no advantage to using any of these equations
in older adults; none was deemed superior for diagnosis.
5
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References
- Estimated glomerular filtration rate and muscle mass: Their relationship in older inpatients.J Am Med Dir Assoc. 2019; 20: 1469-1471
- Prediction of creatinine clearance from serum creatinine.Nephron. 1976; 16: 31-41
- 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: 461-470
- A new equation to estimate glomerular filtration rate.Ann Intern Med. 2009; 150: 604-612
- Diagnostic performance of creatinine-based equations for estimating glomerular filtration rate in adults 65 years and older.JAMA intern Med. 2019; 179: 796-804
- Medications, renal function and kidney injury: A complex interplay, wherein prevention is easier than cure!.J Am Med Dir Assoc. 2014; 15: 692-696
- Chronic kidney disease staging in nursing home and community older adults: Does the choice of Cockcroft-Gault, Modification of Diet in Renal Disease Study, or the Chronic Kidney Disease Epidemiology Collaboration Initiative Equations Matter?.J Am Med Dir Assoc. 2012; 13: 151-155
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Published online: March 02, 2020
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Estimated Glomerular Filtration Rate and Muscle Mass: Their Relationship in Older InpatientsJournal of the American Medical Directors AssociationVol. 20Issue 11
- PreviewThe assessment of renal function drives many therapeutic and diagnostic decisions in everyday practice. Serum creatinine concentration (Cr) provides an unreliable estimate of glomerular filtration rate (eGFR), the optimal measure of which relies on exogenous substances. Because this is unfeasible in daily practice, the surrogate eGFR through Cr-based equations has become the clinical standard. The age-related decline of muscle mass may affect Cr and influence eGFR. The Modification Diet in Renal Disease 4-variable (MDRD),1 the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI),2 and Berlin Initiative Study 1 (BIS-1)3 equations were computed using data from populations with different age composition.
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- Reply to Estimated Glomerular Filtration Rate and Muscle Mass in Older Patients: Diagnostic Accuracy of Creatinine-Based Equations and Implications in PracticeJournal of the American Medical Directors AssociationVol. 21Issue 4
- PreviewWe thank doctors Dharmarayan and Yoo for their comments on our article.1 In line with the literature and our results, they found a substantial lack of consistency among the results of different formulas estimating renal function by investigating a sample including a large proportion of frail older people.2 We believe that this could partly depend on the age-composition of different samples generating such equations, which in turn may reflect differently the age-related decay of skeletal muscle mass.
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