Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versusserum creatinine

Pierre Delanaye,Guillaume Claisse,Manolie Mehdi,Nicolas Maillard,Bernard Lambermont,Alexandre Lautrette,Bernard E Dubois,Etienne Cavalier,Jean-Marie Krzesinski,Jérôme Morel,Pierre Damas,Christophe Mariat

doi:10.1186/1471-2369-15-9

Pierre Delanaye, Guillaume Claisse + Show 10 more

Open Access

https://doi.org/10.1186/1471-2369-15-9

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Abstract

BackgroundDetecting impaired glomerular filtration rate (GFR) is important in intensive care units (ICU) in order to diagnose acute kidney injuries and adjust the dose of renally excreted drugs. Whether serum Cystatin C (SCysC) may better reflect glomerular filtration rate than serum creatinine (SCr) in the context of intensive care medicine is uncertain.MethodsWe compared the performance of SCysC and SCr as biomarkers of GFR in 47 critically ill patients (median SOFA (Sepsis-related Organ Failure Assessment) score of 5) for whom GFR was measured by a reference method (urinary clearance of iohexol).ResultsMean Iohexol clearance averaged 96 ± 54 mL/min and was under 60 mL/min in 28% of patients. Mean SCr and SCysC concentrations were 0.70 ± 0.33 mg/dL and 1.26 ± 0.61 mg/L, respectively. Area under the ROC curve for a GFR threshold of 60 mL/min was 0.799 and 0.942 for SCr and SCysC, respectively (p = 0.014).ConclusionsWe conclude that ScysC significantly outperfoms SCr for the detection of an impaired GFR in critically ill patients.Trial registrationClinicalTrials.gov: B7072006347

Highlights

Detecting impaired glomerular filtration rate (GFR) is important in intensive care units (ICU) in order to diagnose acute kidney injuries and adjust the dose of renally excreted drugs
We study the ability of serum creatinine (SCr), ScysCbased and combined equations to estimate GFR in these ICU patients [14]
We studied the performance of the most widely used SCr- and ScysC-based equations, i.e. the Modification of Diet in Renal Disease (MDRD) [16] and the CKDEpidemiology Collaboration (CKD-EPI) equations (Table 1) [14]

Summary

Introduction

Detecting impaired glomerular filtration rate (GFR) is important in intensive care units (ICU) in order to diagnose acute kidney injuries and adjust the dose of renally excreted drugs. Whether serum Cystatin C (SCysC) may better reflect glomerular filtration rate than serum creatinine (SCr) in the context of intensive care medicine is uncertain. Detecting impaired glomerular filtration rate (GFR) is important in intensive care units (ICU) in order to (i) diagnose acute kidney injuries, (ii) prevent further degradation of renal function and (iii) adjust the dose of several renally excreted drugs. SCr is not exclusively cleared by glomerular filtration but is partially secreted by renal tubules. This well-known phenomenon may account for substantial GFR overestimation.

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