Article

Objectives: To determine
(1) the variability of annual creatinine clearance (C-Cr) testing for subjects with chronic spinal cord injury (SCI) and
(2) whether decisions to change neurogenic bladder management are made based on C-Cr. Measurements. Design: Retrospective chart review. Setting: Inpatient Veterans Affairs SCI unit. Participants:
The medical records of 70 men were consecutively selected for review from among 664 veterans enrolled in the SCI clinic. All patient charts had to have at least 5 C-Cr tests performed within 10 years preceding the review. Interventions: Not applicable. Main Outcome Measures: Development of renal insufficiency and change in medical or bladder management of the patient, based on the results of the C-Cr test. Results: For individual patients, the results of 24-hour C-Cr were highly variable from 1 evaluation to the next; the within-subject standard deviation (SD) for C-Cr was 25.9mL/min. The within-subject SD for serum creatinine was 0.12mg/dL. For all comparisons of repeatability, variability, and reliability, serum creatinine was superior to C-Cr. No medical management decisions were made based on the result of the 24-hour creatinine clearance. Renal ultrasound results and postvoid bladder residuals were the major factors in changing medical management with regard to renal function preservation. Conclusions: The Cc, test has little value as a screening measure for renal disease in SCI patients because of its variability in serial testing.

Langue : ANGLAIS