Role of Creatinine Clearance as a Screening Test in Persons With Spinal Cord Injury

Sepahpanah F, Burns SP, McKnight B, Yang CC. Role of creatinine clearance as a screening test in persons with spinal cord injury.ObjectivesTo determine (1) the variability of annual creatinine clearance (CCr) testing for subjects with chronic spinal cord injury (SCI) and (2) whether decisions to change neurogenic bladder management are made based on CCr measurements.DesignRetrospective chart review.SettingInpatient Veterans Affairs SCI unit.ParticipantsThe medical records of 70 men were consecutively selected for review from among 664 veterans enrolled in the SCI clinic. All patient charts had to have at least 5 CCr tests performed within 10 years preceding the review.InterventionsNot applicable.Main Outcome MeasuresDevelopment of renal insufficiency and change in medical or bladder management of the patient, based on the results of the CCr test.ResultsFor individual patients, the results of 24-hour CCr were highly variable from 1 evaluation to the next; the within-subject standard deviation (SD) for CCr was 25.9mL/min. The within-subject SD for serum creatinine was 0.12mg/dL. For all comparisons of repeatability, variability, and reliability, serum creatinine was superior to CCr. No medical management decisions were made based on the result of the 24-hour creatinine clearance. Renal ultrasound results and postvoid bladder residuals were the major factors in changing medical management with regard to renal function preservation.ConclusionsThe CCr test has little value as a screening measure for renal disease in SCI patients because of its variability in serial testing.