Pharmacy World and Science

, Volume 20, Issue 6, pp 258–263 | Cite as

Can two, four or eight‐hour urine collections after voluntary voiding be used instead of twenty ‐four hour collections for the estimation of creatinine clearance in healthy subjects

  • Sophia L. Markantonis
  • Eftychia Agathokleous‐Kioupaki


The accuracy of creatinine clearance estimations obtained from 4‐hour (16:00‐20:00, 20:00‐24:00, 08:00‐12:00, 12:00‐16:00) and 8‐hour (16:00‐24:00, 24:00‐08:00 and 08:00‐16:00) urine collections and the Cockcroft Gault formula compared with the standard 24‐hour collection, as well as the cyclical variation in creatinine excretion were studied in a group of 22 healthy subjects (Serum creatinine < 1.5mg/dl, Blood Urea Nitrogen < 50mg/dl) after voluntary voiding. The mean 4‐hour and 8‐hour creatinine clearances were not significantly different from the 24‐hour values. Clearance values from 8‐hour collections between 24:00‐08:00 and 16:00‐24:00 were found to be the most accurate and gave the best correlations. Furthermore only the mean absolute percentage deviations of the 8‐hour from the 24‐hour clearance values were significantly less than 20%. Significant cyclical variations in creatinine clearance over 24 hours were not observed. Time intervals between 23:00‐07:00 and 07:00‐09:00 were chosen for the comparisons between 8‐hour, 2‐hour, Cockcroft Gault creatinine clearance estimations and the 24‐hour values in 21 healthy subjects. The mean 2‐hour and 8‐hour creatinine clearances were not significantly different from the 24‐hour values. However, once again only the 8‐hour clearance values differed by less than 20% from the 24‐hour values and they were more accurate and better correlated than the 2‐hour values. As expected, in both groups of subjects, the percentage of clearance values that deviated by more than 20% from the 24‐hour values decreased as the length of the collection times increased. The Cockcroft Gault formula in both groups of volunteers gave less accurate clearance estimations, smaller correlation coefficients (not statistically significant in Group I subjects) and percentage deviations from the 24‐hour values greater than 20%. Undetected early stage renal insufficiency in three volunteers and the use of actual instead of normalized Scr values may have been the cause of these poor clearance estimations. In healthy subjects (Scr < 1.5mg/dl) 24‐hour creatinine clearance may be estimated from an 8‐hour urine collection with voluntary voiding if a 20% deviation from the 24‐hour value is considered clinically acceptable.

Creatinine clearance healthy subjects shorter urine collection periods voluntary voiding 


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  1. 1.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.Google Scholar
  2. 2.
    Bjornsson TD. Use of serum creatinine concentrations to determine renal function. Clin Pharmacokin 1979;4:200–2.Google Scholar
  3. 3.
    Jelliffe RW. Creatinine clearance: bedside estimate. Ann Intern Med. 1973;79:604–5.Google Scholar
  4. 4.
    Jelliffe RW. Estimation of creatinine clearance when urine cannot be collected. Lancet 1971;1:975–6.Google Scholar
  5. 5.
    Wagner JG. Theory and practice of adjusting dosage of drugs on the basis of endogenous creatinine clearance or serum creatinine concentration. In: Biopharmaceutics and relevant pharmacokinetics. Hamilton,IL: Drug Intelligence Publications;1972:222–33.Google Scholar
  6. 6.
    Edwards KDG, Whyte HM. Plasma creatinine level and creatinine clearance as test of renal function. Austral Ann Med 1959;8:218–24.Google Scholar
  7. 7.
    Rowe JW, Andres R, Tobin JD, et al. Age-adjusted standards for creatinine clearance. Ann Intern Med 1976;84:567–9.Google Scholar
  8. 8.
    Lott RS, Hayton WL. Estimation of creatinine clearance from serum creatinine concentration. Drug Intell Clin Pharm 1978; 12:140–50.Google Scholar
  9. 9.
    Hull JK, Hak LJ, Koch GC, et al. Influence of range of renal function and liver disease on predictability of creatinine clearance. Clin Pharmacol Ther 1981;29:516–21.Google Scholar
  10. 10.
    Mawer CE, Knowles BR, Lucas SB, et al. Computer-assisted prescribing of kanamycin for patients with renal insufficiency. Lancet 1972;1:12–5.Google Scholar
  11. 11.
    Wheeler LA, Sheiner LB. Clinical estimation of creatinine clearance. Am J Clin Path 1979;72:27–31.Google Scholar
  12. 12.
    Rhodes PJ, Rhodes RS, McClelland GH, et al. Evaluation of eight methods for estimating creatinine clearance in men. Clin Pharm 1987;6:399–406.Google Scholar
  13. 13.
    Richardson JA, Philbin PE. The one-hour creatinine clearance rate in healthy men. JAMA 1971;216:987–90.Google Scholar
  14. 14.
    Singh A, Clugh KS, Sharma BK. Three-hour endogenous creatinine clearance (Ccr) as a test of glomerular filtration (GFR) in normal subjects and patients with chronic renal failure. Indian J Med Sci 1979;33:61–4.Google Scholar
  15. 15.
    Wilson RF, Soullier G. The validity of 2-hour creatinine clearance studies in critically ill patients. Crit Care Med 1980;8:281–4.Google Scholar
  16. 16.
    Classon RN. Comparison of 24-hour and 2-hour urine collection periods for calculation of creatinine clearance. ASHPMidyear-Clinical-Meeting 1993;28:P–143(E).Google Scholar
  17. 17.
    Baumann TJ, Staddon JE, Horst HM, Bivins BA. Minimum urine collection periods for accurate determination of creatinine clearance in critically ill patients. Clin Pharm 1987;6:393–8.Google Scholar
  18. 18.
    Moore-Ede MC, Czeisler CA, Richardson GS. Circadian timekeeping in health and disease. Part 2. Clinical implications of circadian rhythmicity. N Engl J Med 1983; 309:530–6.Google Scholar
  19. 19.
    Doe RP, Vennes JA, Flink EB. Diurnal variation of 17-hydroxycorticosteroids, sodium, potassium, magnesium and creatinine in normal subjects and in cases of treated adrenal insufficiency and Cushing's syndrome. J Clin Endocrinol Metab 1960;20:253–65.Google Scholar
  20. 20.
    Pasternack A, Kuhback B. Diurnal variations of serum and urine creatine and creatinine. Scand J Clin Lab Invest 1971;27:1–7.Google Scholar
  21. 21.
    Haeckel R. Assay of creatinine in serum, with use of fuller's earth to remove interferents. Clin Chem 1981;27:179–83.Google Scholar
  22. 22.
    Knoll VE, Wisser H, Rebel FC. Dependence of the serum concentrations of creatinine and urea on the time of day, with normal and impaired kidney function. J Clin Chem Clin Biochem 1978;16:567–70.Google Scholar
  23. 23.
    O'Connell MB, Wong MO, Bannick-Mohrland SD, Dwinell AM. Accuracy of 2-and 8-hour urine collections for measuring creatinine clearance in the hospitalized elderly. Pharmacotherapy 1993;13(2):135–42.Google Scholar
  24. 24.
    Chow MSS, Schweizer R. Estimation of renal creatinine clearance in patients with unstable serum creatinine concentrations: comparison of multiple methods. Drug Intell Clin Pharm 1985;19:385–90.Google Scholar
  25. 25.
    Wesson LG, Lauler DP. Diurnal cycle of glomerular filtration rate and sodium and chloride excretion during responses to altered salt and water balance in man. J Clin Invest 1961;40:1967–77.Google Scholar
  26. 26.
    Camara AA, Arn KD, Reimer A, et al. The twenty-four hourly endogenous creatinine clearance as a clinical measure of the functional state of the kidneys. J Lab Clin Med 1951;37:749–768.Google Scholar
  27. 27.
    Sirota JH, Baldwin DS, Villarreal H. Diurnal variations of renal function in man. J Clin Invest 1950;29:187–92.Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Sophia L. Markantonis
    • 1
  • Eftychia Agathokleous‐Kioupaki
    • 1
  1. 1.Laboratory of Biopharmaceutics and PharmacokineticsDepartment of PharmacyAthensGreece

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