Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan.
Department of Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan.
J Anesth. 2019 Feb;33(1):155-158. doi: 10.1007/s00540-018-2596-3. Epub 2019 Jan 2.
The aim of this study is to assess the accuracy of creatinine clearance (CCr) calculated by the Cockcroft-Gault (CG) equation for elderly patients in a Japanese hospital. This study was a retrospective chart review of patients aged ≥ 55 years with a CCr measurement by a 24-h urine collection (24-h) prior to general surgery in our hospital between April 2009 and March 2017. In total, 1028 Japanese patients were included (mean age 73.0 ± 8.9 years). The serum creatinine value was 0.82 ± 0.24 mg/dL. The CCr estimated by CG and measured by 24 h was 64.2 ± 20.9 mL/min and 71.5 ± 21.0 mL/min, respectively. The CG CCr was significantly underestimated in patients aged ≥ 65 years, and the discrepancy exhibited an age-dependent character. The error was reached at 21.7 ± 13.2 mL/min in patients aged ≥ 90 years (P < 0.001). The age-dependent errors almost completely disappeared when the modified CG equation was used, in which the term of age in the original CG equation was constantly regarded as 65, if the patient was 65 years or older. Anesthesiologists and intensivists should pay attention to the potential risk of underestimating kidney function when using the CG equation for Japanese elderly patients.
本研究旨在评估 Cockcroft-Gault（CG）方程估算日本医院老年患者肌酐清除率（CCr）的准确性。该研究是对 2009 年 4 月至 2017 年 3 月期间我院行普外科手术的≥55 岁患者进行的回顾性图表审查，这些患者在手术前均通过 24 小时尿液收集（24h）测量了 CCr。共纳入 1028 例日本患者（平均年龄 73.0±8.9 岁），血清肌酐值为 0.82±0.24mg/dL。CG 估算的 CCr 和 24h 测量的 CCr 分别为 64.2±20.9mL/min 和 71.5±21.0mL/min。CG CCr 在年龄≥65 岁的患者中明显被低估，且这种差异具有年龄依赖性。在年龄≥90 岁的患者中，误差达到 21.7±13.2mL/min（P<0.001）。当使用改良的 CG 方程时，年龄依赖性误差几乎完全消失，在改良的 CG 方程中，将原始 CG 方程中年龄项始终视为 65，如果患者≥65 岁。麻醉师和重症监护医生在使用 CG 方程估算日本老年患者的肾功能时，应注意低估肾功能的潜在风险。
