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Received Nov 14, 2017; Revised Mar 12, 2018; Accepted Mar 28, 2018
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1. Background
Prevalence of chronic kidney disease (CKD) in the elderly is increasing globally as life expectancy continues to improve [1]. According to the latest report from the Department of Statistics Malaysia, life expectancy at birth in Malaysia is 72.7 years for male and 77.4 years for female [2]. From previous literatures, we know that serum creatinine alone is imprecise to assess kidney function in the elderly [3]. Apart from age, the level can also be affected by gender, muscle mass, diet, and tubular creatinine secretion particularly at reduced glomerular filtration rate (GFR); this is especially important in older people. Serum creatinine based equation such as Cockcroft-Gault corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is widely used to overcome the shortcomings of serum creatinine alone in estimating GFR [4–6].
In this part of the world, creatinine based formula remained an important tool for assessment of kidney function. The main bulk of patients are being treated at the peripheral hospitals and clinics by the primary healthcare practitioner. A small proportion will present to major hospitals during illnesses and later transferred over back to the community for further management. This is partly due to the difficulty transporting elderly patients to major hospitals which are usually situated in the cities. Therefore, the use of GFR estimating equations in the out-patient settings will help the healthcare practitioner in deciding the need and timing of referrals for subspecialty management.
Serum cystatin-C is a small molecular weight protein produced by all nucleated cells, freely filtered by glomerulus then reabsorbed and completely degraded (but not secreted) by proximal tubules [7, 8]. It is present in serum, saliva, semen, urine, and cerebrospinal fluid and the level is not affected by muscle mass, and hence it is ideal to be used in elderly patients especially those with malnutrition. In a meta-analysis by Dharnidharka et al., serum cystatin-C was found to be superior to serum creatinine as a...
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