Vega Jorge, Huidobro E Juan Pablo
Departamento de Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile.
Servicio de Medicina Interna, Sección de Nefrología, Hospital Naval A. Nef., Viña del Mar, Chile.
Rev Med Chil. 2021 Mar;149(3):409-421. doi: 10.4067/s0034-98872021000300409.
The evaluation of renal function in older adults is usually carried out with a creatinine clearance or an estimation of glomerular filtration rate using formulas such as Cockcroft-Gault, MDRD or CKD-EPI. The results obtained with these formulas are often regarded as equivalent. However, in adults older than 70 years, the Cockcroft-Gault formula frequently underestimates the glomerular filtration rate with respect to reference methods and the MDRD formula overestimates it. CKD-EPI has a more unpredictable behavior. This leads to erroneously classifying patients in the stages of chronic kidney disease (CKD), artificially increasing the prevalence of this condition, overloading health systems and generating emotional disorders in patients mistakenly classified as carriers of CKD. Also, when kidney function is overestimated, CKD patients are prevented from receiving the treatments appropriate for their condition. In recent years, new formulas have been proposed (FAS, BIS) with a greater accuracy to estimate glomerular filtration rate in older adults. This review describes the behavior of these formulas in a significant number of older adults, from various countries, and proposes using those equations with the best performance in older adults.
老年人肾功能评估通常采用肌酐清除率或使用Cockcroft-Gault、MDRD或CKD-EPI等公式估算肾小球滤过率。这些公式得出的结果通常被视为等效。然而，对于70岁以上的成年人，Cockcroft-Gault公式相对于参考方法常常低估肾小球滤过率，而MDRD公式则高估它。CKD-EPI的表现更不可预测。这导致在慢性肾脏病（CKD）分期中对患者进行错误分类，人为增加了这种疾病的患病率，给卫生系统带来负担，并在被错误分类为CKD患者的人群中引发情绪障碍。此外，当肾功能被高估时，CKD患者无法接受适合其病情的治疗。近年来，已提出了新的公式（FAS、BIS），在估算老年人肾小球滤过率方面具有更高的准确性。本综述描述了这些公式在来自不同国家的大量老年人中的表现，并建议使用在老年人中表现最佳的那些公式。
