Role of Creatinine Clearance as a Screening Test in Persons With Spinal Cord Injury

Abstract 

Sepahpanah F, Burns SP, McKnight B, Yang CC. Role of creatinine clearance as a screening test in persons with spinal cord injury.

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 C_Cr test has little value as a screening measure for renal disease in SCI patients because of its variability in serial testing.

Key Words:  Bladder, neurogenic , Creatinine , Kidney function tests , Rehabilitation , Reproducibility of results , Spinal cord injuries