Kurtal Hanife, Schwenger Vedat, Azzaro Marina, Abdollahnia Nadja, Steinhagen-Thiessen Elisabeth, Nieczaj Rolf, Schulz Ralf-Joachim
Charité - Universitatsmedizin Berlin, Campus Virchow-Klinikum, Research Group on Geriatrics, Ev Geriatriezentrum Berlin, Berlin, Germany.
Gerontology. 2009;55(3):288-95. doi: 10.1159/000172982. Epub 2008 Nov 12.
Geriatric patients frequently have impaired renal function. Multimorbidity leads to polypharmacy with high risk of adverse drug reactions.
The aim was to evaluate the prevalence of renal impairment and risk of overdosing renally excreted drugs in hospitalized geriatric patients.
In 221 patients aged >or=65 years, GFR was estimated by the MDRD, Cockcroft-Gault (CG) and lean body mass (LBM)-adjusted CG equations.
A reduced renal function (<60 ml/min/1.73 m(2)) was found in 43% by MDRD, 61% by CG, and 71.9% by LBM-CG. The prevalence of severe impairment (<30 ml/min/1.73 m(2)) was 3.3% based on MDRD, 5.4% on CG, and 13.6% on LBM-CG. At mean 10 medications were applied simultaneously. In patients with reduced eGFR, 52% of medications required dosage adjustment. Unfractionated heparins, ACE inhibitors, antibiotics, diuretics, and potassium were frequently used.
For all limitations of formulaic GFR estimation in the elderly, routine assessment of renal function by reporting of eGFR helps to identify patients with chronic kidney disease and supports drug dosing. Implementation of routine reporting of eGFR is mandatory in standardized geriatric assessment.
老年患者常伴有肾功能受损。多种疾病并存导致用药种类繁多，药物不良反应风险高。
评估住院老年患者肾功能损害的患病率及经肾脏排泄药物过量的风险。
对221例年龄≥65岁的患者，采用MDRD公式、Cockcroft-Gault（CG）公式以及基于瘦体重（LBM）校正的CG公式估算肾小球滤过率（GFR）。
采用MDRD公式估算，43%的患者肾功能降低（<60 ml/min/1.73 m²）；采用CG公式估算，该比例为61%；采用基于LBM校正的CG公式估算，该比例为71.9%。根据MDRD公式，严重肾功能损害（<30 ml/min/1.73 m²）的患病率为3.3%；根据CG公式为5.4%；根据基于LBM校正的CG公式为13.6%。平均每位患者同时使用10种药物。估算肾小球滤过率（eGFR）降低的患者中，52%的药物需要调整剂量。普通肝素、血管紧张素转换酶抑制剂、抗生素、利尿剂和钾制剂是常用药物。
尽管老年患者公式法估算GFR存在局限性，但通过报告eGFR进行肾功能常规评估有助于识别慢性肾脏病患者并辅助调整药物剂量。在标准化老年评估中，强制实施eGFR常规报告。
