Insuficiencia renal oculta en atención primaria. ¿Un problema exclusivo de mujeres? / Occult renal failure in primary care, a women problem ?

Introducción: La insuficiencia renal crónica se está convirtiendo en un problema de salud pública. La estimación del filtrado glomerular (FG) mediante fórmulas permite detectar las personas con daño renal. Objetivo: Conocer el porcentaje de personasatendidas en atención primaria con insuficiencia renal (IR) oculta definida por presentar un FG estimado < 60 mL/min/1,73 m2, con niveles de creatinina séricadentro de los límites de referencia del laboratorio (< 1,3 mg/dL en hombres y < 1,2 mg/dL en mujeres), que hubiesen pasado desapercibidas. Método: Personas mayores de 18 años atendidas en Atención Primaria del Área de Salud de Plasencia (Cáceres) a las que su médico de atención primaria solicitó la medición de niveles de creatinina, entre el 1 de marzo y el 31 de julio de 2006 (5 meses). Se estimó el FG usando la fórmula MDRD-4 y se clasificó el grado de IR de acuerdo con las guías DOQI de la NKF. Resultados: Se realizaron 13.784 mediciones de creatinina sérica en mayores de 18 años. 1.042 presentaron FG < 60 mL/min/1,73 m2, correspondientesa 960 personas (6,96%). Edad media 76,8 años (rango 40-98). De ellas, 418 (43,5%) presentaban IR «oculta», todas mujeres, con edad media 76,5 años y Crmedia 1 mg/dL. Conclusiones: Existe un elevado porcentaje de pacientes atendidos en atención primaria con FG < 60 mL/min/1,73 m2 que mantiene niveles de creatinina en los límites normales. La estimación del FG de forma sistemática permite detectar dichos pacientes, fundamentalmente mujeres mayores de 65 años, que pasarían desapercibidos, lo que se ha denominado IR «oculta»

Background: Chronic renal failure is becoming a public health problem. The estimation of glomerular filtration rate (GFR) using the MDRD-4 equation is importantto find out patients with impaired renal function. The aim of this study was to determinate the rate of patients took care in Primary Care with «occult» renal failure, defined as a GFR less than 60 mL/min/1.73 m2, and serum creatinine levels in the normal range of the laboratory (< 1.3 mg/dL for men, and < 1.2 mg/dL for women).Methods: Patients over 18 years-old took cared in Primary Care of the health area of Plasencia (Caceres), who were measured serum creatinine level between march to july 2006. We estimated GFR using MDRD-4 formula and classified the level of kidney function according to the NKF-DOQI guidelines.Results: We estimated GFR in 13.784 analyses. In 1.042 the GFR was less than 60 mL/min/1.73m2, from 960 patients(6.96%). Mean age 76.8 years (range 40-98 years). 418 keep normal serum creatinine levels (43.5%). Conclusion: Renal impairment seems to be prevalent in the general population took care in Primary Care. An elevated rate of patients with renal failure present serum creatinine levels in the laboratory normal range, «occult» renal failure. The systematic estimation of GFR using MDRD formula is necessary to detect this patients with renal impairment

[Occult renal failure in primary care. A women's problem?]. / Insuficiencia renal oculta en atención primaria. Un problema exclusivo de mujeres?

BACKGROUND: Chronic renal failure is becoming a public health problem. The estimation of glomerular filtration rate (GFR) using the MDRD-4 equation is important to find out patients with impaired renal function. The aim of this study was to determinate the rate of patients took care in Primary Care with "occult" renal failure, defined as a GFR less than 60 mL/min/1.73m2, and serum creatinine levels in the normal range of the laboratory (< 1.3 mg/dL for men, and < 1.2 mg/dL for women). METHODS: Patients over 18 years-old took cared in Primary Care of the health area of Plasencia (Caceres), who were measured serum creatinine level between March to July 2006. We estimated GFR using MDRD-4 formula and classified the level of kidney function according to the NKF-DOQI guidelines. RESULTS: We estimated GFR in 13.784 analyses. In 1.042 the GFR was less than 60 mL/min/1.73m2, from 960 patients (6.96%). Mean age 76.8 years (range 40-98 years). 418 keep normal serum creatinine levels (43.5%). CONCLUSION: Renal impairment seems to be prevalent in the general population took care in Primary Care. An elevated rate of patients with renal failure present serum creatinine levels in the laboratory normal range, "occult" renal failure. The systematic estimation of GFR using MDRD formula is necessary to detect this patients with renal impairment.