Journal of Gerontological Nursing

CNE Article 

Optimal Screening Cut-Off Points for Renal Impairment in Rural Korean Older Adults Taking Medications

Chun-Ja Kim, PhD, RN; Dong-soo Shin, PhD, RN

Abstract

The purpose of this descriptive, cross-sectional study was to identify the optimal cut-off point of estimated glomerular filtration rate (eGFR) using the area under the receiver operating characteristic curve to screen for renal impairment among rural Korean older adults taking medications (N = 100). Renal function was assessed by eGFR using the Cockcroft-Gault formula. Nearly half of participants took five or more prescription drugs, and 46% took nephrotoxic medications. Participants’ optimal eGFR cut-off points in screening for renal impairment with and without polypharmacy were 54.3 mL/min (area under curve [AUC] = 0.824, p < 0.001) and 61.4 mL/min (AUC = 0.768, p < 0.001), respectively. The incidence of renal impairment was 61.2% and 56.9%, respectively, using 54.3 mL/min and 61.4 mL/min as the new optimal cut-offs of eGFR with and without polypharmacy. More than half of the rural older adults require a reduction in medication dosage or a change to non-nephrotoxic medications. These new optimal cut-off points using eGFR according to polypharmacy may be helpful in screening for renal impairment among rural older adults taking medications.

Abstract

The purpose of this descriptive, cross-sectional study was to identify the optimal cut-off point of estimated glomerular filtration rate (eGFR) using the area under the receiver operating characteristic curve to screen for renal impairment among rural Korean older adults taking medications (N = 100). Renal function was assessed by eGFR using the Cockcroft-Gault formula. Nearly half of participants took five or more prescription drugs, and 46% took nephrotoxic medications. Participants’ optimal eGFR cut-off points in screening for renal impairment with and without polypharmacy were 54.3 mL/min (area under curve [AUC] = 0.824, p < 0.001) and 61.4 mL/min (AUC = 0.768, p < 0.001), respectively. The incidence of renal impairment was 61.2% and 56.9%, respectively, using 54.3 mL/min and 61.4 mL/min as the new optimal cut-offs of eGFR with and without polypharmacy. More than half of the rural older adults require a reduction in medication dosage or a change to non-nephrotoxic medications. These new optimal cut-off points using eGFR according to polypharmacy may be helpful in screening for renal impairment among rural older adults taking medications.

Dr. Kim is Assistant Professor, Ajou University College of Nursing, Suwon, and Dr. Shin is Associate Professor, Hallym University, Division of Nursing, Okchen-dong Chuncheon Kangwondo, South Korea.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. This work was supported by the Korea Research Foundation Grant funded by the Korean Government (KRF-2008-331-E00414) and Hallym University Research Fund (HRF-2008-040).

Address correspondence to Dong-Soo Shin, PhD, RN, Associate Professor, Hallym University, Division of Nursing, Okchen-dong Chuncheon Kangwondo, South Korea; e-mail: shindong@hallym.ac.kr.

Received: June 27, 2009
Accepted: January 11, 2010
Posted Online: April 27, 2010

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Authors

Dr. Kim is Assistant Professor, Ajou University College of Nursing, Suwon, and Dr. Shin is Associate Professor, Hallym University, Division of Nursing, Okchen-dong Chuncheon Kangwondo, South Korea.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. This work was supported by the Korea Research Foundation Grant funded by the Korean Government (KRF-2008-331-E00414) and Hallym University Research Fund (HRF-2008-040).

Address correspondence to Dong-Soo Shin, PhD, RN, Associate Professor, Hallym University, Division of Nursing, Okchen-dong Chuncheon Kangwondo, South Korea; e-mail: .shindong@hallym.ac.kr

10.3928/00989134-20100330-07

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