Optimizing an Online Screening Approach for Renal Function Estimation with Patient''s Serum Creatinine and Age

• Main Authors: Hsiu-Hua Tung, 董秀花
• Other Authors: Yung-Jin Lee
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/33172506852989655395

碩士 === 高雄醫學大學 === 藥學研究所 === 97 === ABSTRCT Aim: The aim of this study attempted to find an optimal ceiterion which could be used to screen out all possible patient’s whose eGFR was below 50 mL/min. The method was hopefully to screen more than 80% patients whose eGFRs were less than 50 mL/min and the leastof patients whose eGFRs were greater than 50 mL/min. Also this method should be easy to implement into hospital mainframe computer as alertingfunction that could give warningto clinicians when the criterion was met. Methods: We collected all clinical data from September, 2008 to January, 2009 from inpatients population who were using antimicrobials and Scr≧1.0 mg/dL in a hospital. Estimated glomerular filtration rate (e-GFR) was calculated with both Cockcroft-Gault (CG) equation and Modification of Diet in Renal Disease Study Equation (MDRD4). We then set eGFR-CG or eGFR-MDRD4 as the standard indexes to explore the optimal age and Scr for patient’s renal function when patients’s body weights were not available. Results: There were 7,381 patients’ data collected in this study with male patients69%, mean age64.9 years old, mean body weight 61.9 kg, mean eGFR-CG 41.9 mL/min and eGFR-MDRD4 was 50.1 mL/min/1.73m2. There were 4,895 patients whose eGFR-CG was less than 50 mL/min. If we used Scr >1.5mL/min as the cutting-off point, we only screened out 2,525 (51.6%) patients.When we used age older than 65 as the cut-off point, only 3,754 (76.7%) patients would be screened out. However, more than 80% of patients whose eGFR-CG were less than 50 mL/min, If we applied both the age and Scr level as the screening criteria. The optimal cut-off pointwas both patient’s age older than 54 years and patient’s Scr ≧1.1 mg/dL. However the cut-off would be different (i.e., patient’s age was greater than 58 years old and patient’s Scr ≧1.2 mg/dL), when using eGFR-MDRD4 as the standard index. Conclusions: Our study showed that solely using Scr>1.5 mg/dl as the screening index of CKD could be seriously underestimated for almost 50% of patients whose eGFRs were less than 50 mL/min. We finally proposed that using both Age ≧ 54 years and Scr≧1.1 mg/dL would be the most efficient method for screening CKD patients. Key words: Creatinine, Estimated Glomerular Filtration rate (e-GFR), Cockcroft-Gault (CG) Equation, Modification of Diet in Renal Disease Study Equation (MDRD).