老年患者估算肾小球滤过率自动报告的临床价值

Clinical value of automatic reporting of estimated glomerular filtration rate in geriatrics.

作者信息

Kurtal Hanife, Schwenger Vedat, Azzaro Marina, Abdollahnia Nadja, Steinhagen-Thiessen Elisabeth, Nieczaj Rolf, Schulz Ralf-Joachim

机构信息

Charité - Universitatsmedizin Berlin, Campus Virchow-Klinikum, Research Group on Geriatrics, Ev Geriatriezentrum Berlin, Berlin, Germany.

出版信息

Gerontology. 2009;55(3):288-95. doi: 10.1159/000172982. Epub 2008 Nov 12.

DOI:10.1159/000172982

PMID:19001785

Abstract

BACKGROUND

Geriatric patients frequently have impaired renal function. Multimorbidity leads to polypharmacy with high risk of adverse drug reactions.

OBJECTIVE

The aim was to evaluate the prevalence of renal impairment and risk of overdosing renally excreted drugs in hospitalized geriatric patients.

METHODS

In 221 patients aged >or=65 years, GFR was estimated by the MDRD, Cockcroft-Gault (CG) and lean body mass (LBM)-adjusted CG equations.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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。

目的

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。

方法

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）。

结果

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。