Abstract :
Despite increasing use in clinical practice, an estimated glomerular filtration rate value
(eGFR) of <60 ml/min/1.73 m2 does not necessarily indicate the existence of chronic renal insufficiency (CRI)
and this may lead to an over-estimate of CRI particularly in persons seventy years or older. Aim: To find a
screening test able to differentiate CRI from the decrease in GFR normally associated with the renal ageing
process. Methods: Medical information of 487 individuals of both sexes aged 16-102 was obtained from
nephrologists, internal medicine physicians, cardiologists, geriatricians, family and nuclear medicine doctors
from Argentina, Portugal and Spain. Data were assessed and statistically analysed using logistic regression
techniques. From the discriminative variables it was derived the HUGE formula. Results: A formula including
haematocrit , blood urea, and gender (HUGE), diagnoses CRI regardless of the variables of age, blood
creatinine, creatinine clearance, or other eGFR. The HUGE formula is: L= 2.505458 – (0.264418 x Hematocrit) +
(0.118100 x Urea) [+ 1.383960 if male]. If L is a negative number the individual does not have CRI; if L is a
positive number, CRI is present. Our data demonstrate that the HUGE formula is more reliable than MDRD and
CKD-EPI, particularly in persons aged over 70. Conclusions: Our HUGE screening formula offers a
straightforward, easily available and inexpensive method for differentiating between CRI and eGFR < 60
ml/min/1.73 m2 that will prevent a considerable number of aged healthy persons, as much as 1.700.000 in Spain
and 2.600.000 in UK, to be excluded from clinical assays or treatments contraindicated in CRI
Keywords :
urea , Chronic renal insufficiency , screening , haematocrit.
