Métodos de evaluación de la función renal en el paciente anciano: fiabilidad e implicaciones clínicas

Chronic renal disease (CRD) is found in a third of the Spanish population aged more than 65 years old. Detection and early treatment would increase survival and help to reduce associated cardiovascular morbidity and mortality as well as the risk of pharmacological iatrogeny. Determination of the glomerular filtration rate has traditionally been considered the best parameter for renal function evaluation, which should not be based exclusively on serum creatinine concentration or creatinine clearance. The application of predictive equations is useful in the diagnosis, classification and outpatient management of patients with CRD. Most studies performed in the elderly have found that the Modification of Diet in Renal Disease (MDRD-4) has greater precision and accuracy than the Cockcroft-Gault formula, and is considered the nomogram of choice in this age group. The Cockcroft-Gault formula can be used when rapid estimation of renal function or drug adjustments are required, so long as the limitations of this method are taken into account.