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Age and Ageing Advance Access originally published online on September 19, 2009
Age and Ageing 2009 38(6):698-703; doi:10.1093/ageing/afp168
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© The Author 2009. Published by Oxford University Press [on behalf of the British Geriatrics Society]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Modified diet in renal disease method overestimates renal function in selected elderly patients*

Gregory William Roberts1, Pernille Maria Ibsen2 and Charlotte Teglman Schiøler2

1 Pharmacy Department, Repatriation General Hospital, Daw Park, SA 5041, Australia
2 Danish University of Pharmaceutical Sciences, Copenhagen, Denmark

Address correspondence to: G. W. Roberts. Tel: (+61) 8 82751632; Fax: (+61) 8 83740225. Email: Greg.Roberts2{at}health.sa.gov.au

Background: the Modification of Diet in Renal Disease (MDRD) method of renal function estimation has not been extensively assessed in elderly patients. We needed to assess which renal function estimate was most suited for drug dose estimation in our population.

Method: we compared MDRD with an optimised version of the Cockcroft–Gault (CGopt) method in a hospital population, using gentamicin clearance as a baseline.

Results: MDRD overestimated gentamicin clearance by 29% (P < 0.001, n = 68), while CGopt underestimated by 10% (P < 0.01). Overestimation by MDRD increased with increasing age. This was 12%, 26% and 69% in age groups <65, 65–80 and >80 years respectively (P < 0.001). CGopt underestimated renal function by –5%, –16% and –4% respectively (P = NS). Bias and precision of renal function estimations for the three age groups were less for CGopt than for MDRD. Age significantly influenced MDRD overestimation in this population (P = 0.037).

Conclusion: MDRD overestimated renal function as age increased. While CGopt underestimated renal function, this was of a smaller magnitude, consistent across age, and thus better suited for dose calculation, especially in the elderly. Larger-scale studies using gold standard markers of renal function estimation are urgently needed to determine the accuracy of MDRD in elderly hospitalised patients.

Keywords: elderly, creatinine, gentamicin, drug dosing

*Institutions where study performed

1. Repatriation General Hospital, Daw Park, SA 5041, Australia

2. Flinders Medical Centre, Bedford Park, SA 5041, Australia

Received 5 February 2009; accepted in revised form 8 July 2009.


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