 Prediction of Creatinine Clearance from Clinical Parameters Contributed by Ajay Singh, MD, Parmjeet Randhawa, MD, Michael Nalesnik, MD, and Robert Bourne Creatinine clearance is a much more sensitive index of renal function than serum creatinine, but its measurement requires a 24 hour collection of urine, which is not practical or feasible in every clinical setting. Cockroft and Gault have developed a formula to estimate creatinine clearance based on the age of the patient, the sex, the weight, and the serum creatinine (Formula 1). In patients with renal disease, Levey, et al (using patients enrolled in the Modification of Diet in Renal Disease (MDRD) study) have devised a more accurate formula which takes into account the serum albumin and patient demography when calculating the estimated GFR (Formula 2). Additionally, Nankivell et aldescribed three alternative formulae which correlated with the true glomerular filtration rate in kidney transplant recipients. These formulae require the use of additional parameters such as blood urea (Formula 3), or blood urea, and height of the patient (Formula 4). Corrections can also be made for the blood hemoglobin, dialysis time before transplantation, follow up time after transplantation, and use of cadaveric donors (Formula 5).
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ReferencesCockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999 Mar 16;130(6):461-70. Nankivell BJ, Gruenewald SM, Allen RD, Chapman JR. Predicting glomerular filtration rate after kidney transplantation. Transplantation. 1995 Jun 27;59(12):1683-9.
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