Abstract
Objectives
the association between renal function and delirium has not been investigated in older
fracture patients. Creatinine is frequently low in these subjects, which may influence
the association between delirium and renal function as estimated with creatinine-based
formulas. Cystatin C could be a more reliable filtration marker in these patients.
Aim
to confirm the association between renal function and delirium in older fracture patients
comparing creatinine- and cystatin-based estimated glomerular filtration rate (eGFR)
Methods
patients aged 65+ requiring surgery for traumatic bone fractures were included. Six
equations were used to calculate eGFR, based on serum creatinine and/or cystatin C
obtained within 24 h of admission: Modification of Diet in Renal Disease (MDRD), Chronic
Kidney Disease Epidemiology (CKD-EPIcr, CKD-EPIcys, CKD-EPIcr-cys) and Berlin Initiative Study equations (BIS-1, BIS-2). Delirium was identified with
a chart-based method.
Results
571 patients (mean age 83) were enrolled. Delirium occurred in the 34% and was associated
with a lower eGFR regardless of the equation used. In a multivariable model, the association
between moderate renal impairment (eGFR 30–60 ml/min/1.73 m2) and delirium remained significant in patients aged 75–84 and only when estimated
with cystatin-based or BIS-1 equations. Only dementia was significantly associated
with delirium in subjects 85+.
Conclusions
in older fracture patients, moderate renal impairment was independently associated
with delirium only among subjects aged 75–84, when eGFR was estimated with cystatin-based
or BIS 1 equations, and not with the most commonly used equations (MDRD, CKD-EPIcr).
Keywords
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Article info
Publication history
Published online: November 08, 2019
Accepted:
October 17,
2019
Received in revised form:
September 24,
2019
Received:
June 22,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
