Validación de las ecuaciones predictivas del filtrado glomerular en pacientes adultos con enfermedad renal crónica
The Chronic Kidney Disease (CKD) represents one of the pathologies with greater incidence and prevalence in the present sanitary systems. The ambulatory application of different methods that allow a suitable detection, monitoring and stratification of the renal functionalism is of vital importance in the habitual practice. On the basis of the vagueness obtained by means of the application of the serum creatinine, they have been developed to everything a set of predictive equations for the estimation of the glomerular filtration rate (GFR). The current guidelines of the European Renal Association (ERA-EDTA) and the Kidney Disease Outcomes Quality Initiative (K/DOQI) recommend the Cockcroft-Gault (CG) formula and the MDRD (Modification of Diet in Renal Disease) equation in adult patients with CKD stage 4 (GFR: 29-15 ml/min/1,73m²). Nevertheless, it is essential the knowledge of the limitations in clinical practice.
The main aim of first article was to evaluate the accuracy of different prediction equations for the ambulatory follow-up of a cohort of patients with type 2 diabetes mellitus (a total of 525 isotopic determination with 125I-iothalamate clearance in 87 patients). The control mean using the isotopic technique was 10 years (range: 7-15). In conclusion, based on our results, the use of the prediction equations during the follow-up period of type 2 diabetic patients proved inaccurate in cases of hyperfiltration and normal renal function. It is in situations of CKD stages 2-3 (GFR: 89-30 ml/min/1,73m²), with mean creatinine levels ? 133 µmol/l (1,5 mg/dl), that the MDRD equation can be started to be used for GFR estimation during the monitoring and follow-up of patients with type 2 diabetes receiving insulin and/or oral antidiabetic drugs.
The main aim of second article was to ascertain the usefulness of prediction equations with respect to nutritional status and age in a group of 87 Caucasian adult patients with CKD stages 4-5 (GFR range: 8-30 ml/min/1,73m²). According to our results in the group of patients with higher creatinine production (CP) and age ? 64, results of the present data offered no evidence for superiority of the MDRD equation over the CG formula in patients with advanced renal failure. Thus, we do not recommend the use of the mean creatinine and urea clearance adjusted to 1,73 m² of BSA which was the most imprecise equation. The application of all the equations is inaccurate in patients with lower CP with or without advanced age, implying the premature start of renal substitution treatment.
In conclusion, it is essential for clinical the knowledge of limitations in the application of prediction equations, specially in situations of normal renal function and hyperfiltration, certain associate pathologies and extreme situations of nutritional status and age. In these cases, is more recommendable the application of isotopic techniques for the calculation of renal function.
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Advisor:Bonal Bastons, Jordi; Romero González, Ramón
School:Universitat Autónoma de Barcelona
Source Type:Master's Thesis
Keywords:417 departament de medicina
Date of Publication:10/19/2007