Review
New tools for the management of renal function in the elderly: Berlin Initiative Study equation and hematocrit, urea and gender formulae
Nuevas herramientas para abordar la función renal en ancianos: la ecuación Berlin Initiative Study y la fórmula hematocrito, urea y género
Manuel Heras
, María José Fernández-Reyes
Corresponding author
Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain
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equation and hematocrit, urea and gender formulae" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "450" "paginaFinal" => "454" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel Heras, María José Fernández-Reyes" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Manuel" "apellidos" => "Heras" "email" => array:2 [ 0 => "mherasb@saludcastillayleon.es" 1 => "manuhebe@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María José" "apellidos" => "Fernández-Reyes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevas herramientas para abordar la función renal en ancianos: la ecuación <span class="elsevierStyleItalic">Berlin Initiative Study</span> y la fórmula hematocrito, urea y género" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1527 "Ancho" => 1542 "Tamanyo" => 90173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Glomerular filtration rate estimated by BIS1 and MDRD-4 and considering the baseline serum creatinine groups.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The glomerular filtration rate (GFR) is widely accepted as the best method to determine renal function.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> KDOQI guidelines for chronic kidney disease (CKD) recommend knowing the levels of GFR, which has allowed to know CKD prevalence in the general population.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2,3</span></a> However, with this CKD definition-classification based on the level of GFR (the presence of a GFR estimated by formulas lower than 60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m is considered a CKD, in stages 3–5<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a>), we found that CKD increases in the elderly population. This finding may not be entirely correct if we consider that with age a number of changes affecting both the structure and renal function occur, whose common denominator is the decreased renal functional reserve.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> Among the functional changes, one of the most important is the one that affects GFR: it is known that, after 30 years of age, the GFR decreases at an average rate of 1<span class="elsevierStyleHsp" style=""></span>ml/min/year. Therefore, not all elderly with a decline in GFR value is renal insufficient.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">5</span></a> The kidneys, apart from performing a filtering function, are also able to maintain homeostasis of the internal environment by performing other functions such as absorption and removal of water and solutes or regulation of acid–base balance and also performs an endocrine function.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">6</span></a> Therefore, the CKD is characterized by a progressive and irreversible loss of all these functions in which the kidney is involved, and as a result various changes occur, such as the anaemic syndrome and acid–base balance disorders, as well as the bone-mineral metabolism.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> Thus, with the simplification of the definition of CKD, with current KDOQI guidelines, based on the GFR, many older people may be wrongly classified as renal patients according to a GFR lower than 60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>. Among people aged 64 or more, epidemiological studies show a CKD prevalence ranging from 21.4% in the Spanish study EPIRCE, 23% in US studies and 35% in Canadian and Finnish studies. These results have been obtained with the use of the <span class="elsevierStyleItalic">Modification of Diet in Renal Disease</span> (MDRD) equation. However, if we apply another method to estimate GFR, as the Cockroft-Gault formula, the prevalence of CKD would increase.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8,9</span></a> In our study Elderly with chronic kidney disease of the Segovia Hospital, out of 80 elderly patients, we would find that, if we were to use the MDRD, CKD-EPI and Cockroft-Gault formulas in the same patients, the prevalence of CKD (GFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>) would be 70, 83.70 and 87.2%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">GFR being the most accepted marker to assess renal function, its clinical application should focus on concrete situations where we need to assess renal function; for example, in cases where there is a need to administer a correct dose of drugs with renal excretion, assessment of the viability of kidneys in older donors, or in patients with elevated serum creatinine to determine the degree of renal disease and subsequent monitoring of the same, in the planning decisions regarding renal replacement therapy, rather than using it to make systematic measurements of GFR estimation equations for the entire population, so as to automatically classify an elderly subject as affected by CKD should his/her GFR value be <60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> with such equations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Nephrology controversy about the systematic estimation of glomerular filtration rate and serum creatinine determination</span><p id="par0015" class="elsevierStylePara elsevierViewall">Nephrology has generated a controversy about the advisability of systematically knowing the GFR in the whole population.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">12,13</span></a> Serum creatinine is a component of 113<span class="elsevierStyleHsp" style=""></span>Da, derived from creatine in skeletal muscle, which is not considered a good renal function marker because of having the disadvantage of also translating muscle mass and protein intake; however, most formulas used to obtain the GFR are developed from the serum creatinine determination.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> In the editorial of Dr. Robles a few years ago, “On the calculation of glomerular filtration: a sceptical view” he noted that although the MDRD is a new tool to know the GFR, this equation is obtained from serum creatinine, which, in any case, it is simpler and less costly and therefore a good way to address renal function in approximate terms.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a> Standardizing on the entire population of the determination of GFR using mathematical formulas can lead to finding a decreased GFR in certain situations, with dubious utility in clinical practice, particularly in the elderly. Therefore, with the data from our study, we established cross-sectional correlations of creatinine and GFR with parameters associated with kidney disease such as urea, uric acid, calcium and potassium.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10,11</span></a> In our study, serum creatinine correlated with laboratory abnormalities which are often associated when there is renal failure, such as potassium (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.26, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.021) and calcium (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.24, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.032), which did not happen for GFR estimated by MDRD and Cockcroft-Gault, and we concluded that the determination of GFR in the elderly does not seem to offer advantages over a simple serum creatinine determination.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">How to measure the glomerular filtration rate?</span><p id="par0020" class="elsevierStylePara elsevierViewall">GFR exact measurement is not usually performed in clinical practice because it is very laborious and expensive, since it requires administering exogenous markers such as inulin.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> Therefore, to know the GFR we usually resort to endogenous markers such as creatinine and cystatin C for estimations.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> These markers have been the source from which most equations are designed to estimate GFR, such as Cockroft-Gault formula,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> the MDRD<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> and CKD-EPI.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> However, most of these equations have been underdeveloped in the elderly population.</p><p id="par0025" class="elsevierStylePara elsevierViewall">New equations have been recently developed, specifically designed for the population aged 70 or more, to estimate the GFR in this population group: the <span class="elsevierStyleItalic">Berlin Initiative Study</span> (BIS) equations.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">21,22</span></a> And to try to discriminate whether a reduced GFR (<60<span class="elsevierStyleHsp" style=""></span>ml/min/year) is due to a physiological process associated with ageing or, on the contrary, is a CKD, the haematocrit, urea and gender (HUGE) formula was created.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Glomerular filtration rate estimation in elderly patients with the 1 and 2 <span class="elsevierStyleItalic">Berlin Initiative Study</span> equations</span><p id="par0030" class="elsevierStylePara elsevierViewall">From the BIS cohort of patients, which included 2073 subjects, a subgroup of 610 people aged 70 or more was selected to study the approach of renal function in these individuals and to develop and validate the new equations for this purpose.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> Finally, the sample included 570 participants, whose clearance was measured using iohexol as the gold standard, and with these data 2 new equations to estimate GFR in the elderly were developed. For the design of these formulas, variables such as age, sex, serum creatinine and cystatin C were considered. Race was not considered as they were all Caucasian.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The final BIS2 equation to estimate GFR included age, sex, serum creatinine and cystatin C; is as follows:<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0040" class="elsevierStylePara elsevierViewall">To facilitate its applicability in clinical practice, as many centres do not have availability of cystatin C, the BIS1 equation was developed. Serum creatinine is needed for its calculation, in addition to age and sex:<elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0045" class="elsevierStylePara elsevierViewall">To avoid having to resort to manual or computer calculators, nomograms have been designed with the BIS1 equation for both men and women, which allow to simplify the calculation by using serum creatinine and patient age.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">With data from our study,<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10,11</span></a> in the cross-sectional selection period from January to April 2006, 90% of patients had an estimated glomerular filtration rate (GFR) calculated by BIS1<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>. The average levels of eGFR by BIS1 were 42.91<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> (range from 19.00 to 69). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the significant differences between eGFR levels shown by BIS1 and MDRD-4 considering the baseline serum creatinine groups (group 1, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38, creatinine<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1.1<span class="elsevierStyleHsp" style=""></span>mg/dl, and group 2, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42, creatinine<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1.1<span class="elsevierStyleHsp" style=""></span>mg/dl).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Haematocrit, urea and gender formula</span><p id="par0055" class="elsevierStylePara elsevierViewall">In those clinical situations where we find a decreased GFR, particularly in the elderly, where it can be difficult to establish whether this reduction is due to a physiological ageing process or, on the contrary, it is due to a renal disease process, the HUGE formula might be helpful to screen for kidney disease. This formula was developed from general population data, with 487 participants in the original study where it was designed (206 women and 281 men), with an age range between 16 and 101 years, with haematocrit, urea and gender (formula HUGE) being among the variables included<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a>:<elsevierMultimedia ident="eq0015"></elsevierMultimedia></p><p id="par0060" class="elsevierStylePara elsevierViewall">Kidney failure is considered when the patient obtains a value (<span class="elsevierStyleItalic">L</span>) number greater than 0. If a negative number is obtained, the subject does not have renal failure.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The HUGE formula has been tested using databases that include a total of 125,373 subjects, of which 40,369 were over 70 years of age, confirming its validity in the renal insufficiency screening.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">CKD prevalence using the HUGE formula</span><p id="par0070" class="elsevierStylePara elsevierViewall">In a recent cross-sectional study to evaluate the CKD detection capability using the HUGE formula on a sample of Spanish population that included a total of 2813 subjects, the prevalence of CKD in the general population was 2.2% and this increased significantly with age: 5% for the age group between 60 and 70 years of age and 9.8% for people over 70 years of age.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a> In either case, these values were lower than those obtained if the MDRD-4 formula is applied. We have also tested the HUGE formula in our study patients,<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10,11</span></a> finding that out of a group of 67 patients studied, with the HUGE formula only 21 of them (13 men and 8 women; 31.3%) had a HUGE value of >0 and therefore, renal failure, whereas if we apply the MDRD-4 formula in these 67 patients, 45 (15 males and 30 females; 67.2%) would have a GFR lower than 60<span class="elsevierStyleHsp" style=""></span>ml/min, so, according to the KDOQI guidelines, they should be considered as kidney patients.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">27</span></a> That is, we could be mistakenly labelling as kidney patients one third of healthy people in our study patients, mainly women, with the use of the MDRD-4 formula.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Prognostic utility of the HUGE formula in situations associated with kidney disease</span><p id="par0075" class="elsevierStylePara elsevierViewall">Patients with CKD are more likely to have episodes of acute renal failure and, in turn, each of these episodes contributes to a further deterioration of renal function.<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">28,29</span></a> With data from our study,<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10,11</span></a> patients who had a HUGE value<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0 were those who had significantly more episodes of acute renal failure during follow-up.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> Furthermore, these patients with HUGE<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0 were the ones who significantly increased serum creatinine levels during follow-up (baseline creatinine: 1.95<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.59 and at 36 months: 2.30<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.68) compared to patients who had a HUGE<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0 in the baseline.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> The HUGE formula has also shown the ability to discern, among patients with diabetic nephropathy, who are more likely to have progressive kidney failure.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Regarding the morbidity and mortality associated to CKD, it is known that renal patients have a higher morbidity and mortality than the general population.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> In our study, patients with a baseline HUGE higher than 0 were those with significant mortality during the 8 years of follow up, as can be seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Study of renal function in elderly patients</span><p id="par0085" class="elsevierStylePara elsevierViewall">A diagnostic algorithm for kidney treatment of elderly patients is proposed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, the estimation of GFR with mathematical formulas should not be done routinely in all the elderly; the new BIS1 equations and the HUGE formula are useful tools for addressing both renal function and renal disease in this population group.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Key concepts</span><p id="par0095" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0100" class="elsevierStylePara elsevierViewall">Elderly patients may have a reduced GFR (<60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>) according to age, without necessarily implying the presence of renal disease.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Well-nourished patients with lab serum creatinine within the normal range and without changes in urinalysis should be considered free from kidney disease and, therefore, GFR estimation would not be relevant in them.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0110" class="elsevierStylePara elsevierViewall">GFR estimation should be done with clear objectives, such us: adjustment of drugs with renal metabolism, viability of kidneys from older donors or patients with elevated serum creatinine likely to have kidney disease.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Most of the mathematical formulas used to estimate GFR in recent years (Cockroft-Gault, MDRD, CKD-EPI) are obtained from serum creatinine concentrations. These three formulas have great clinical variability in the levels of GFR (same patient can be labelled in different categories of renal disease, depending on the formula used) and also these equations have been underdeveloped in the elderly population, something which represents a clear limitation.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0120" class="elsevierStylePara elsevierViewall">The BIS1 equation can be useful for estimating GFR in people aged 70 years or more.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0125" class="elsevierStylePara elsevierViewall">In clinical situations where there is doubt as to whether a GFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> estimated with mathematical formulas is due to the intrinsic ageing process or associated kidney disease, the HUGE formula could be of great clinical utility.</p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">There has been no funding.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">There are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres729252" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec733310" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres729253" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec733309" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Nephrology controversy about the systematic estimation of glomerular filtration rate and serum creatinine determination" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "How to measure the glomerular filtration rate?" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Glomerular filtration rate estimation in elderly patients with the 1 and 2 Berlin Initiative Study equations" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Haematocrit, urea and gender formula" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "CKD prevalence using the HUGE formula" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Prognostic utility of the HUGE formula in situations associated with kidney disease" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Study of renal function in elderly patients" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Key concepts" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-04" "fechaAceptado" => "2016-01-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec733310" "palabras" => array:3 [ 0 => "Glomerular filtration rate" 1 => "Berlin Initiative Study equation" 2 => "Hematocrit, urea, gender formulae" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec733309" "palabras" => array:3 [ 0 => "Filtrado glomerular" 1 => "Ecuación Berlin Initiative Study" 2 => "Fórmula hematocrito, urea y género" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In the last few years a debate has emerged on the range of normal renal function in the elderly, and if every elderly person with a glomerular filtration rate estimated using formulas (Cockroft-Gault, MDRD, CKD-EPI) of less than 60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> has kidney disease. In this review we analyzed, based on the results of the study Elderly people with chronic kidney disease of the Hospital de Segovia, the new equations to measure kidney function in the elderly: the Berlin Initiative Study equation designed to estimate the glomerular filtration rate in people aged 70 or more, and the hematocrit, urea and gender formula to establish whether an elderly person with a glomerular filtration rate lower than 60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> has kidney disease.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En los últimos años se ha generado un debate sobre el rango normal de función renal en el anciano, y si todo anciano con filtrado glomerular estimado por fórmulas (Cockroft-Gault, MDRD, CKD-EPI) menor de 60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> tiene una enfermedad renal. En esta revisión analizamos, con base en los datos del estudio Ancianos con enfermedad renal crónica del Hospital de Segovia, las nuevas ecuaciones para medir la función renal en ancianos: la <span class="elsevierStyleItalic">Berlin Initiative Study</span>, diseñada para estimar el filtrado glomerular en personas de 70 años o más, y la fórmula hematocrito, urea y género para diferenciar si un anciano con FG menor de 60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> tiene enfermedad renal.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Heras M, Fernández-Reyes MJ. Nuevas herramientas para abordar la función renal en ancianos: la ecuación <span class="elsevierStyleItalic">Berlin Initiative Study</span> y la fórmula hematocrito, urea y género. Med Clin (Barc). 2016;146:450–454.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1527 "Ancho" => 1542 "Tamanyo" => 90173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Glomerular filtration rate estimated by BIS1 and MDRD-4 and considering the baseline serum creatinine groups.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1790 "Ancho" => 1499 "Tamanyo" => 88823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier curve of mortality according to the baseline HUGE formula value.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3019 "Ancho" => 2290 "Tamanyo" => 263140 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm for managing kidney function and chronic kidney disease in the elderly. 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