We studied whether there are any discrepancies between serum creatinine and CrCl, the variables which would predict abnormal creatinine clearance, and analyzed the usage of Metformin in a nursing home setting. We evaluated nursing home residents with diabetes to assess if appropriate considerations with regard to renal function were made before prescribing Metformin. To our knowledge no study exclusively focused on a nursing home population. However, the studies above were generally performed in community-based practices. The risks and benefits of the use of Metformin need to be weighed in deciding whether patients with renal impairment should be treated with Metformin. However, clinical studies have not established a specific limit of CrCl below which Metformin would be inappropriate for use. Citation11 Varying levels of CrCl ranging from 30 mL/min to 70 mL/min, Citation12–17 have all been suggested as limits below which Metformin should not be prescribed. Citation10 It is recommended to avoid Metformin in renal impairment, defined as serum creatinine levels of 1.5 mg/dL in men and 1.4 mg/dL in women or with abnormal CrCl. In a pharmacokinetic evaluation of Metformin using CrCl to assess renal function, patients with normal renal function had a significantly lower mean half-life as compared to patients with renal dysfunction. Citation9 Therefore, nursing homes residents are potentially at risk for such concerns. Citation7, Citation8 In the USA, 17% of patients diagnosed with lactic acidosis due to Metformin were over 80 years of age. For example, Metformin, used to treat type 2 diabetes, Citation5, Citation6 has been associated with lactic acidosis in patients with reduced CrCl. This is particularly relevant for drugs whose clearance or potential side effects are affected by renal function. They are particularly vulnerable to this phenomenon of renal function discrepancy between serum creatinine and CrCl measurements.Īs muscle mass plays an important role in determining serum creatinine, nursing home residents with reduced muscle mass require a more accurate measure of their renal function (e.g., CrCl to determine drug dosing). Many nursing home residents are older and/or physically debilitated, with reduced muscle mass. Citation3, Citation4 Since serum creatinine falls as muscle mass decreases, this renal function decline may appear as normal serum creatinine but with abnormal CrCl. As people age, their muscle mass decreases Citation2, Citation3 simultaneously many older people also undergo a decline in renal function. Citation1 One major factor that affects serum creatinine levels is muscle mass. Creatinine clearance (CrCl) is a more accurate measurement of renal function than serum creatinine.
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