Van den Noortgate N J, Janssens W H, Afschrift M B, Lameire N H
University Hospital Ghent, Department of Internal Medicine, Belgium.
Int Urol Nephrol. 2001;32(4):531-7. doi: 10.1023/a:1014454031451.
Evaluation of renal function and relation to risk factors for renal failure in very old patients admitted to an acute geriatric ward.
Retrospective chart review of patients aged 80 years and over, admitted to the acute geriatric ward from August 1998 till August 1999. Recorded data were: age, gender, previous medical history, primary diagnosis, medication use, weight, serum creatinine, BUN, sodium, potassium, cholesterol, urine and ultrasound of the kidney. The creatinine clearance was estimated by the Cockcroft-Gault formula, the glomerular filtration rate by the MDRD equation.
220 (60 males/160 females) patients were included. The mean serum creatinine on admisssion and discharge was 1.17 +/- 0.45 mg/dL and 1.11 +/- 0.48 mg/dL respectively. The mean estimated creatinine clearance in the very old was 38.11 +/- 12.04 mL/min on admission and 39.00 +/- 11.01 mL/min on discharge. Renal failure arbitrarily defined as an estimated creatinine clearance on admission of less than 30 mL/min was found in 26.4% of the patients. Only a significant correlation between failure to thrive and renal failure was found (p < 0.0001). The correlation coefficient between the Cockcroft-Gault and the MDRD formula was r = 0.66 (p < 0.0001); between the Cockcroft-Gault and the reciprocal serum creatinine was r = 0.60 (p < 0.0001) and between the MDRD and the reciprocal serum creatinine was r = 0.87 (p < 0.0001).
The weak correlation between the Cockcroft-Gault and other estimations of GFR in the acutely ill elderly, confirms the need to have a reliable estimation of glomerular filtration rate in the elderly. Renal failure defined as a Cockgroft-Gault <30 mL/min is found in 26.4% of the oldest-old admitted to an acute geriatric department. The elderly with renal failure is more often admitted for failure to thrive. No great differences were observed between renal function on admission and discharge.
评估入住急性老年病房的高龄患者的肾功能及其与肾衰竭危险因素的关系。
对1998年8月至1999年8月入住急性老年病房的80岁及以上患者进行回顾性病历审查。记录的数据有：年龄、性别、既往病史、初步诊断、用药情况、体重、血清肌酐、尿素氮、钠、钾、胆固醇、尿液及肾脏超声检查结果。采用Cockcroft-Gault公式估算肌酐清除率，采用MDRD方程估算肾小球滤过率。
纳入220例患者（60例男性/160例女性）。入院时和出院时的平均血清肌酐分别为1.17±0.45mg/dL和1.11±0.48mg/dL。高龄患者入院时的平均估算肌酐清除率为38.11±12.04mL/min，出院时为39.00±11.01mL/min。26.4%的患者入院时估算肌酐清除率低于30mL/min，被定义为肾衰竭。仅发现衰弱与肾衰竭之间存在显著相关性（p<0.0001）。Cockcroft-Gault公式与MDRD公式之间的相关系数为r=0.66（p<0.0001）；Cockcroft-Gault公式与血清肌酐倒数之间的相关系数为r=0.60（p<0.0001），MDRD公式与血清肌酐倒数之间的相关系数为r=0.87（p<0.0001）。
Cockcroft-Gault公式与急性病老年患者其他肾小球滤过率估算值之间的弱相关性，证实了对老年人肾小球滤过率进行可靠估算的必要性。在入住急性老年科的高龄患者中，26.4%被发现存在Cockgroft-Gault公式估算值<30mL/min的肾衰竭情况。肾衰竭的老年人更常因衰弱而入院。入院时和出院时的肾功能未观察到明显差异。
