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PubMed2000

Variability in the relationship between serum creatinine and creatinine clearance in hypertensives and normotensives with normal renal function.

Variabilities exist in the relationship between serum creatinine (Se-C) and creatinine clearance (CCr) due to the influences of age, muscle mass and gender on creatinine production. We studied this variability in a group of hypertensives (n = 62, 30 male, age 44 +/- 7 years) and normotensives (n = 90, 47 male, age 42 +/- 10 years) with normal renal function (Se-C < 1.5 mg/dL). There was a wide scatter of CCr about each Se-C value. Se-C was higher in males than females and in hypertensives than normotensives, but the differences were not statistically significant. Mean Se-C for the whole group was 0.91 +/- 0.23 mg/dL and corresponded to CCr of 93 +/- 23 mL/min and 93 +/- 21 mL/min before and after adjustment to a body surface area (BSA) of 1.73 m2. Adjusted CCr was significantly lower in hypertensives than normotensives in males (86 +/- 20 mL/min Vs 99 +/- 21 mL/min, P < 0.01) and females (84 +/- 19 mL/min Vs 96 +/- 19 mL/min, P < 0.01). Crude CCr was significantly higher in men than women (P < 0.05) in the whole group but not significantly in the normotensive or hypertensive subgroups. After adjustment, the differences diminished and became insignificant in the whole group. Some subgroups had identical mean Se-C values but different adjusted CCr. A particular Se-C value did not always indicate a particular CCr. Adjustment of CCr to 1.73 m2 BSA reduced the variability between Se-C and CCr and the difference between the genders. CCr showed significant difference in renal function between subgroups where Se-C did not.

Adult↗
PubMed1996

Bilirubin and metamizol do not interfere with the randox enzymatic creatinine test. An evaluation of a new enzymatic creatinine determination method.

We evaluated the new commercially available enzymatic test kit for creatinine (Randox Laboratories Ltd. Ardmore, Crumlin, UK). The test correlated well with the reference HPLC method (yenz = 0.98x + 1.4; r = 1.00; n = 72). The correlations with the Jaffe method (yenz = 1.00x + 14.1; r = 0.99; n = 72) and the dry slide technique (yenz = 1.07x + 4.1; r = 1.00; n = 72) were also good, but these techniques gave slightly higher creatinine results than the HPLC or the Randox enzymatic method. This new test is insensitive to bilirubin interference. It has been reported that patients receiving metamizol showed unusually low values of creatinine, when determined enzymatically, but this drug does not interfere with the Randox method. The test evaluated is more specific than enzymatic methods published earlier and it provides an attractive alternative to the traditional picrate test.

Bilirubin↗
PubMed1988

Serum creatinine and creatinine clearance in healthy neonates and prematures during the first 10 days of life.

Normal serum creatinine (Scr) and creatinine clearance (Ccr) values during the first 10 days of life were obtained in 63 very premature (28-32 weeks of gestation), premature (33-37 weeks) and term infants (38-42 weeks). Scr fell, and Ccr rose less markedly in the very premature infants. Scr was 80 mumol/l on the 1st day of life both in very premature and premature infants, and 77 mumol/l in full-term neonates. After 10 days, Scr was 73, 53 and 35 mumol/l respectively. There was an exponential correlation between Ccr and gestational age, indicating rapid maturation of glomerular function.

Creatinine↗
PubMed2000

Prediction of creatinine clearance from serum creatinine in patients with rheumatoid arthritis: comparison of six formulae and one nomogram.

The estimation of glomerular filtration rate is important for the medical treatment of patients with rheumatoid arthritis (RA). However, the determination of endogenous creatinine clearance (Clcr) from a 24-h urine collection is an unreliable and time-consuming procedure. We therefore tested the accuracy of six equations and one nomogram for the prediction of Clcr from serum creatinine (Scr) in 38 patients with RA and 20 controls. A positive correlation was found for all methods in the controls (r = 0.83-0.94) and RA patients (r = 0.51-0.69). The methods did not overestimate Clcr in RA. In the RA group the simple formula published by Cockcroft [Clcr = ((140 - age) x body weight)/(72 x Scr), x 0.85 for females] showed the best correlation with the measured Clcr. In RA the Cockroft formula can reliably be used to predict Clcr from Scr.

Adult↗
PubMed1980

Evaluation of serum creatinine measurement by the direct acidification method for errors contributed by non-creatinine chromogens.

Serum creatinine determination by the direct acidification method was found to be non-specific. Chromogens other than creatinine could react with alkaline picrate and their developed color was also destroyed by acid. Only elevated levels of bilirubin and acetoacetate caused a significant interfering effect. The degree of this interference depended on: (1) the amount of the interfering substance; (2) the reaction time allowed for color development; and (3) the final acidity for decolorization.

Acetoacetates↗
PubMed2006

Estimated creatinine clearance instead of plasma creatinine level as prognostic test for postoperative renal function in patients undergoing coronary artery bypass surgery.

BACKGROUND: Preoperative renal failure is a risk factor for adverse events in cardiac surgery. Serum creatinine (SCr) is the most used test for renal failure. However, patients can have significantly decreased glomerular filtration rates with normal SCr levels. More accurate approximation of renal function can be obtained using the Cockroft-Gault equation to calculate an estimated creatinine clearance (CrCl) rate from SCr. METHODS: This study included 627 patients undergoing an isolated CABG between January 2003 and September 2004. CrCl was calculated using the Cockroft-Gault formula. Patients were divided in group A-SCr, 576 patients (91.1%) with a good renal function, SCr < or =1.20 mg/dL for women and < or =1.40 mg/dL for men, and a group B-SCr, with impaired renal function, 51 patients (8.1%). CrCl < or = 50 mL/min was chosen to reflect renal impairment. Group A-CrCl (555 patients, 88.5%) had a normal renal function and group B-CrCl (72 patients,11.5%) an impaired renal function. The studied outcomes were hospital mortality, hospital morbidity, and postoperative renal failure. RESULTS: There was no statistical significant difference between A-SCr and B-SCr group according to the studied outcomes. On the contrary, using the CrCl there was a statistical significant difference between A-CrCl and B-CrCl for the percentage of postoperative renal failure 10 patients (1.8%) versus 5 patients (6.9%) (p=0.00), hospital morbidity 75 patients (13.5%) versus 16 patients (22.2%) (p=0.04). Hospital mortality, 11 patients (2%) versus 4 patients (5.6%), was not significantly (p=0.06) different. Postoperative dialysis, four patients (0.7%) versus three patients (4.2%) (p=0.00), stroke, three patients (0.5%) versus three patients (4.2%) (p=0.00), and hospital stay (7.6 days vs 11.0 days) (p=0.01) were significantly different. CONCLUSION: This study documents that the association between preoperative renal failure and adverse outcomes after CABG is stronger with the estimated CrCl than with the routinely used SCr. Routine estimation or measurement of glomerular filtration rate should be preferred to SCr as screening method for the detection of higher risk patients undergoing CABG.

Acute Kidney Injury↗
PubMed2003

Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality.

OBJECTIVES: We hypothesized that impaired renal function would also be associated with poorer clinical outcomes among patients with ST-segment elevation myocardial infarction (STEMI) treated with fibrinolysis. BACKGROUND: Previous studies have demonstrated that impaired renal function is associated with poorer clinical outcomes in the setting of unstable angina and non-STEMI and after percutaneous coronary intervention. METHODS: Data were drawn from the Thrombolysis In Myocardial Infarction (TIMI)-10, TIMI-14, and Intravenous nPA for the Treatment of Infarcting Myocardium Early (InTIME-II) trials. RESULTS: Within each TIMI risk score (TRS) for STEMI category (0 to 2, 3 to 4, >/=5), 30-day mortality increased stepwise among patients with normal (creatinine [Cr] </=1.2 mg/dl), mildly (Cr >1.2 to 2 mg/dl), and severely (Cr >2.0 mg/dl) impaired renal function (p < 0.001) and in patients with normal (creatinine clearance [CrCl] >/=90 ml/min), mildly (60 to <90 ml/min), moderately (30 to <60 ml/min), and severely (<30 ml/min) impaired CrCl (p < 0.001). Impaired renal function was associated with increased mortality after adjusting for previously identified correlates of mortality (using Cr: odds ratio [OR] for mild impairment 1.52, 95% confidence interval [CI] 1.30 to 1.77, p < 0.001; OR for severe impairment 3.73, 95% CI 2.55 to 5.45, p < 0.001; using CrCl: OR for mild impairment 1.38, 95% CI 1.10 to 1.73, p = 0.006; OR for moderate impairment 2.06, 95% CI 1.59 to 2.66, p < 0.001; OR for severe impairment 3.81, 95% CI 2.57 to 5.65, p < 0.001). CONCLUSIONS: In the setting of STEMI, elevated Cr and/or impaired CrCl on presentation is associated with increased mortality, independent of other conventional risk factors and TRS. This association does not appear to be mediated by reduced fibrinolytic efficacy among patients with impaired renal function or by the presence of congestive heart failure on presentation.

Aged↗
PubMed1981

Prediction of creatinine clearance from serum creatinine concentration based on lean body mass.

An equation for predicting endogenous creatinine clearance (CrCl) in adults and children (with both stable and unstable renal function) from serum creatinine concentration is presented. The predictions are compared with four other available estimating methods, bases on values in 110 subjects with renal impairment of widely differing degrees. In patients with stable and with unstable renal function the corelaion between measured and predicted CrCl was better with the new equation. In patients with rapid changing renal function the new equation resulted in accurate predictions CrCl within a few hours after the change, as opposed to several with the other methods. The elimination rate constant of the aminoglycoside antibiotic amikacin correlated more precisely with CrCl values estimated from the new equation that with those measured doing 24 hr or with the other prediction methods.

Acute Kidney Injury↗
PubMed1983

Prediction of creatinine clearance from serum creatinine in spinal cord injury patients.

Measured endogenous creatinine clearance (Ccr) was compared with the predicted Ccr in 22 paraplegic, 36 tetraplegic and 11 ambulatory male individuals as well as 11 ambulatory females all of whom had normal renal function. While the predicted and measured values closely matched in the ambulatory patients the predicted values in the spinal cord injured patients consistently exceeded the measured values. It thus appears that the original Cockcroft and Gault formula; (formula; see text) when applied to SCI patients can be misleading. Modification of the original formula using a correction factor of 0.8 in paraplegics and 0.6 in tetraplegics was found to allow prediction of Ccr from age, sex, body weight, and serum creatinine in these patients with reasonable accuracy.

Adult↗
PubMed2004

Comparison of cystatin C, creatinine and creatinine clearance vs. GFR for detection of renal failure in renal transplant patients.

BACKGROUND: Serum cystatin C (Scyst) has been suggested as an alternative index of glomerular filtration rate (GFR) and could be useful in renal transplant patients. METHODS: In a 60-subject cohort (40 +/- 12 years old), we compared the simultaneous measurements of Scyst, serum creatinine (Screat), creatinine clearance (Ccreat), Cockcroft and Gault's estimated clearance (Ccg) and GFR measured using inulin clearance (Cin). Receiver operating characteristic (ROC) analysis was performed using two Cin cut-off (60 and 90 mL/min/1.73 m2). RESULTS: A significant correlation was found among Cin on one hand and 1/Scyst, Ccreat, 1/Screat and Ccg on the other hand. Best fits (sensitivity/specificity) at 90 mL/min/1.73 m2 were 1.18 mg/L (0.72/0.80) for Scyst, 1.32 mg/dL (0.67/0.90) for Screat, 77 mL/min (0.80/0.70) for Ccg and 104 mL/min (0.88/0.80) for Ccreat. The areas under the ROC curves were not significantly different. CONCLUSIONS: This study provides cut-off values for Screat and Ccg for detection of renal failure in renal transplant patients. However, the results also suggest that Scyst is not a more sensitive marker than Screat or Ccg for detecting renal failure in renal transplant patients.

Adult↗
PubMed2002

Accuracy of short-duration creatinine clearance determinations in predicting 24-hour creatinine clearance in critically ill and injured patients.

BACKGROUND: We hypothesized that measured 2-hour (CrCl2), 6-hour (CrCl6), and 16-hour (CrCl16) urine creatinine clearance accurately reflect measured (CrCl24meas) and calculated 24-hour CrCl (CrCl24calc) in critical illness. METHODS: Urine was collected in consecutive specimens from 7 am to 9 am (CrCl2), 9 am to 3 pm (CrCl6), and 3 pm to 7 am (CrCl16) at surgical intensive care unit admission and weekly thereafter. CrCl2 and CrCl6 were added to obtain CrCl8, which was then added to CrCl16 to obtain CrCl24meas. CrCl24calc was estimated using the Cockcroft-Gault equation. RESULTS: One hundred patients (45 with trauma) had 131 sets of CrCl2, CrCl6, and CrCl16. Trauma patients were younger; had a lower mean body surface area; and had higher CrCl2, CrCl6, and CrCl16 (all p < 0.0001). Correlation percentages (r2) comparing CrCl2, CrCl6, CrCl8, CrCl16, and CrCl24calc with CrCl24meas in trauma patients were 0.597, 0.760, 0.815, 0.958, and 0.670, respectively. In nontrauma patients, r2 values were 0.516, 0.693, 0.807, 0.946, and 0.649, respectively. CONCLUSION: CrCl2, CrCl6, and CrCl24calc are unreliable for clinical decision making. A minimum collection period of at least 8 hours is recommended for determination of urine creatinine clearance.

Adolescent↗
PubMed1989

Prediction of creatinine clearance from plasma creatinine: comparison of five formulae.

1. Glomerular filtration rate is commonly assessed by measurement of endogenous creatinine clearance (CLcr). Several formulae have been described to calculate CLcr from plasma creatinine and we have evaluated the effectiveness of five formulae in 95 healthy subjects (17 F and 78 M, 20-25 years) and in 72 patients attending a renal clinic (48F and 24 M, 14-69 years). Endogenous CLcr was measured and the CLcr was also estimated by five formulae. 2. In healthy subjects CLcr calculated by the formulae of Cockcroft & Gault (1976) and Mawer et al. (1972) gave higher correlation coefficients than the other three formulae. 3. When all of the subjects with a wide range of CLcr (3.1-164) were considered all formulae gave good correlations, but the formula of Cockcroft & Gault (1976) gave the best estimate.

Adolescent↗
PubMed1993

Measured versus estimated creatinine clearance in patients with low serum creatinine values.

OBJECTIVE: To examine, in patients with a serum creatinine (SCr) < 85 mumol/L, whether the use of actual SCr versus the use of an SCr set at 85 mumol/L and applied to the Cockcroft-Gault method for calculation of creatinine clearance (Clcr), resulted in a similar ability to explain variance in prediction of Clcr. DESIGN: Included in the study were patients with stable renal function receiving total parenteral nutrition, who underwent a 24-hour urine collection and had an SCr < 85 mumol/L. Clcr was calculated (CalcClcr) using the Cockcroft-Gault method, and actual SCr, and an SCr value set at 85 mumol/L (AdjCalcClcr). Calculated values were compared with 24-hour measured Clcr (MeasClcr). SETTING: Inpatient, acute-care hospital. PATIENTS: 33 patients having 33 urine-collection periods. All patients were receiving total parenteral nutrition as their only form of nutritional supplement. Patients who had liver disease, trauma, or burns, or who were receiving certain pharmacologic agents, were excluded from the study. MAIN OUTCOME MEASURES: MeasClcr based on the 24-hour urine collection, CalcClcr computed using the actual measured SCr, and SCr adjusted to 85 mumol/L. RESULTS: A higher proportion of the variance of measured versus calculated Clcr was explained by the using the actual measured SCr value (r2 = 0.68) than SCr adjusted to 85 mumol/L (r2 = 0.32). When analyzed by gender, adjusting the SCr to 85 mumol/L was somewhat better at explaining the variance of measured versus calculated Clcr, but still explained less than 50 percent of the variance. However, the use of the actual SCr explained more of the variance of measured versus calculated Clcr than the use of the SCr value adjusted to 85 mumol/L. CONCLUSIONS: In patients with an SCr < 85 mumol/L, the actual measured SCr should be used when calculating Clcr (regardless of the patient's gender), by the Cockcroft-Gault method.

Aged↗
PubMed2003

Comparison between serum creatinine and creatinine clearance for the prediction of postoperative mortality in patients undergoing major vascular surgery.

BACKGROUND: Poor renal function prior to surgery is associated with increased risk for mortality in patients undergoing major vascular surgery. Traditionally, this function is assessed by serum creatinine concentration (SeCreat). However, SeCreat is also influenced by age, gender and body weight. Hence, creatinine clearance (C(Cr)) is considered to be a better reflection of renal function. This study was undertaken to explore the prognostic value of preoperative calculated Cc, compared to SeCreat for the prediction of postoperative mortality. PATIENTS AND METHODS: The study group comprised 852 consecutive patients who underwent elective major vascular surgery at the Erasmus Medical Center, Rotterdam. Preoperative C(Cr) was calculated based on the Cockroft-Gault equation using preoperative SeCreat, age, body weight and gender. Univariable logistic regression analyses were used to study the relation between preoperative SeCreat, C(Cr) and postoperative mortality. Furthermore, multivariable logistic regression analysis was applied to evaluate the additional predictive value of age, body weight and gender additional to SeCreat. The receiver operating characteristic (ROC) curve was determined to evaluate the predictive power of several regression models for perioperative mortality. RESULTS: Postoperative mortality was 5.9% (50/852) within 30 days of surgery. In a univariable analysis, 10 micromol/l increment of SeCreat were associated with a 20% increased risk of postoperative mortality (OR = 1.2, 95% CI, 1.1-1.3) with an area under the ROC curve of 0.64 (95% CI, 0.56-0.71). If age, gender and body weight were added, the area under the ROC curve increased to 0.70 (95% CI, 0.63-0.77; p < 0.001), indicating that these risk factors had additional prognostic value. Indeed, in a separate regression analysis 10 ml/min decrease in C(Cr) was associated with a 40% increased risk of postoperative mortality (OR = 1.4,95% CI, 1.2-1.5; ROC area: 0.70, 95% CI, 0.63-0.76). ROC curve analysis showed that the cut-off value of 64 ml/min for C(Cr) yielded the highest sensitivity/specificity to predict postoperative mortality. CONCLUSION: Preoperative SeCreat was strongly associated with postoperative mortality, and adding age, gender, and body weight to the model showed improved predictive power indicating that preoperative C(Cr) calculated with these data has additional prognostic value.

Adult↗
PubMed1976

[Creatinine in erythrocytes. Possible effect on plasma creatinine].

Creatinine is present in red cells of healthy individuals in about the same concentration as in plasma. Therefore, hemolysis per se is not a major interference factor in the determination of plasma creatinine, unless the method used is influenced by hemoglobin. Some more important possible influences are discussed.

Creatinine↗
PubMed2004

[Preoperative prediction of creatinine clearance by using serum creatinine].

BACKGROUND: Creatinine clearance (Ccr) is an efficient index of renal function. However, measurement of Ccr is not routinely performed for preoperative patients. To predict preoperative renal impairment, we estimated the preoperative Ccr by using serum creatinine (sCr) and other laboratory findings. METHODS: 702 patients served as the training samples and other 128 patients as the validation samples. (1) Values of sCr and BUN to predict lower Ccr levels were developed from the training samples. In the combination of sCr and BUN, we selected the optimal combination in receiver operating characteristics curve. This value was applied to the validation samples. (2) The predictive equation was derived from the training samples by multiple regression analysis, and it was compared with the equations previously reported. RESULTS: (1) The optimal sensitivity and specificity for predicting Ccr less than 30 ml x min(-1) x 1.48 m(-2) were 60% and 84%, respectively. (2) Among the equations to predict Ccr, our equation showed the highest correlation coefficient (r), and the smallest differences between predicted and measured Ccr. CONCLUSIONS: We determined the values of sCr and BUN to predict renal impairment and derived predictive equation. Our equation was the best to assess the preoperative renal function.

Blood Urea Nitrogen↗
PubMed1987

[Sensitivity and specificity of blood amylase, amylase and creatinine clearance ratio and urinary amylase/urinary creatinine ratio in the diagnosis of acute pancreatitis].

The sensitivity and specificity of amylasemia, the ratios of amylase/creatinine clearance and amylasuria/creatininuria were determined in four groups of patients: a control group (n = 43), patients with acute pancreatitis detected on computed tomography (n = 30, 25 cases of alcoholic pancreatitis), patients with an acute surgical abdomen without pancreatitis (n = 25), and patients with renal failure (n = 20). Sensitivity was defined for the acute pancreatitis group and specificity for the other groups. When amylasemia was greater than 20 UI/dl and the amylasuria/creatininuria ratio greater than 100, sensitivity was 98 per cent. The specificity of these two results in patients with an acute surgical abdomen was 98 per cent. When the ratio amylase/creatinine clearance ratio was greater than 4 sensitivity was 73 per cent and specificity in patients with acute surgical abdomen was 75 per cent. These two values were lower than those of the two preceding tests (p less than 0.01). Sensitivity of the association of an amylasemia greater than 13 UI/dl (m + 2SD) with a clearance ratio greater than 4 was 73 per cent. The amylase/creatinine clearance ratio did not seem to be reliable since its change was delayed with respect to the increase of amylasemia and amylasuria. This ratio has a poor specificity as it increased when the clearance of creatinine decreased in the group with an acute surgical abdomen associated with functional or organic renal failure. In these two groups, the correlation between the amylase/creatinine clearance ratio and creatininemia was significant. This suggested that the clearance of creatinine fell more rapidly than the clearance of amylase as renal failure increased.

Abdomen, Acute↗