Abstract
BackgroundThe Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) has been widely integrated into clinical practice. Although useful in screening for CKD, its’ application in critically ill patients with normal plasma creatinine concentrations remains uncertain. The aim of this study was to assess the performance of CKD-EPI eGFR in comparison to creatinine clearance (CLCR) in this setting.MethodsThis prospective observational study was performed in a tertiary level, university affiliated intensive care unit (ICU). Study participants had to have an expected ICU length of stay > 24 hours, a plasma creatinine concentration < 121 μmol/L, and no history of prior renal replacement therapy or CKD. CKD-EPI eGFR was compared against 8-hour measured urinary CLCR. Data capture occurred within 48 hours of admission.ResultsOne hundred and ten patients (n = 110) were enrolled in the study. 63.6% were male, the mean age was 50.9 (16.9) years, 57.3% received invasive mechanical ventilation, and 30% required vasopressor support. The mean CLCR was 125 (45.1) ml/min/1.73 m2, compared to a CKD-EPI eGFR of 101 (23.7) ml/min/1.73 m2 (P < 0.001). Moderate correlation was evident (r = 0.72), although there was significant bias and imprecision (24.4 +/− 32.5 ml/min/1.73 m2). In those patients with a CKD-EPI eGFR between 60–119 ml/min/1.73 m2 (n = 77), 41.6% displayed augmented renal clearance (CLCR ≥ 130 ml/min/1.73 m2), while 7.8% had a CLCR < 60 ml/min/1.73 m2.ConclusionsThese data suggest CKD-EPI eGFR and measured CLCR produce significantly disparate results when estimating renal function in this population. Clinicians should consider carefully which value they employ in clinical practice, particularly drug dose modification.
Highlights
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate has been widely integrated into clinical practice
Patients were excluded if: a) either invasive haemodynamic monitoring or an indwelling urinary catheter (IDC) were not employed as part of standard management; b) they were < 18 years of age; c) they were pregnant; d) rhabomyolysis was clinically suspected or the admission plasma creatinine kinase was > 5000 IU/L; or e) they were in the ‘risk’ category or greater for acute kidney injury (AKI), as defined by the RIFLE criteria [10]
Plasma CR concentrations were within the normal reference range (68.5 (21.8) μmol/L), and did not change significantly in the following 24 hrs (P = 0.157), where data were available
Summary
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) has been widely integrated into clinical practice. Useful in screening for CKD, its’ application in critically ill patients with normal plasma creatinine concentrations remains uncertain. Accurate assessment of renal function is a priority in the management of critically ill patients. Clinicians regularly utilize such information to help guide drug dosing, optimize fluid, acid–base, and electrolyte management, tailor nutritional requirements, and assess the need for renal replacement therapy (RRT). Rising plasma creatinine (CR) concentrations often trigger clinical interventions, including dose reduction of renally eliminated agents. Driven primarily by a desire to more effectively monitor and screen for chronic kidney disease (CKD), formulae using simple demographic variables have been developed to estimate the glomerular filtration rate (eGFR). The most commonly applied include the Modification of Diet in Renal Disease (MDRD) [3], and newer CKD Epidemiology
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