Serum Creatinine Is an Inadequate Screening Test for Renal Failure in Elderly Patients

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Abstract
THE PREVALENCE of end-stage renal disease (ESRD) is increasing at an alarming rate. In Canada, the number of patients receiving renal replacement therapy was 17 807 as of December 31, 1996, and is projected to be 32952 by 2006.1 Data from the United States predict that the 304 083 patients with ESRD registered in 1997 will have doubled by 2010.2 Elderly patients have the highest incidence rates of ESRD, and their proportion of the population undergoing long-term dialysis is increasing.3,4 Early referral to a nephrologist, or to a multidisciplinary team specializing in ESRD care, has been associated with a reduction in health care costs, morbidity, and mortality in patients starting renal replacement therapy.5-10 Such timely referral requires early detection of kidney disease, and in this respect the most common screening test for renal dysfunction is the serum creatinine.11 Recently published clinical practice guidelines12 acknowledge these facts by addressing the evaluation and referral of patients with elevated levels of serum creatinine.