Abstract
BackgroundIn ICU patients with normal serum creatinine (SCr), a state of increased renal drug excretion has been described (creatinine clearance ≥130 ml/min/1.73 m2), and named augmented renal clearance (ARC). In ICU patients, the accuracy of GFR estimates is insufficient. However, in clinical practice, the physician has not at one’s disposal patient measured creatinine clearance (CrCl) when prescribing. The primary objective of this study was to assess the accuracy of 4 formulas to estimate GFR (Cockcroft-Gault (CG), Robert, sMDRD, and CKD-EPI formulas) with other covariates to detect ARC in ICU patients.MethodsWe enroled 360 consecutive ICU patients with normal SCr in this prospective observational study conducted in a primary teaching hospital. Comparisons between CrCl values and 4 estimated GFR (eGFR) formulas were estimated.ResultsIn these 360 patients, ARC was observed in 33 % of patients most of them trauma. Individual predictive values of equations were poor and the phenomenon increased in ARC subgroup. CG and CKD-EPI were more accurate to detect an ARC. Multivariable analysis showed that the best-fitting model included 3 factors independently correlated to ARC: trauma patients, cut-off values of age ≤58 years, and CKD-EPI more than 108 ml/min/1.73 m2.ConclusionsIn ICU patients with normal SCr, eGFR formulas are imprecise in assessing CrCl. If measured CrCl must be ideally used to detect modifications of the renal function, in clinical practice, age, reason for admission, and CKD-EPI could be used as screening tool to identify ARC.
Highlights
In intensive care unit (ICU) patients with normal serum creatinine (SCr), a state of increased renal drug excretion has been described, and named augmented renal clearance (ARC)
Estimated glomerular filtration rate (GFR) were different between patients presenting ARC and the others
Glomerular hypofiltration (CrCl < 60 ml/min/1.73 m2) was observed in 21.4 % of the cases. 31 patients were classified as stage III CKD by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation
Summary
In ICU patients with normal serum creatinine (SCr), a state of increased renal drug excretion has been described (creatinine clearance ≥130 ml/min/1.73 m2), and named augmented renal clearance (ARC). In ICU patients, the accuracy of GFR estimates is insufficient. The primary objective of this study was to assess the accuracy of 4 formulas to estimate GFR (Cockcroft-Gault (CG), Robert, sMDRD, and CKD-EPI formulas) with other covariates to detect ARC in ICU patients. Direct measurement of the GFR with exogenous substances such as inulin is the gold standard for the assessment of renal function, but is not routinely performed in the intensive care units for practical reasons. In clinical practice, the GFR is most commonly estimated (eGFR) from the serum creatinine (SCr), using various formulas including Cockcroft-Gault, Roberts, Modification of Diet in Renal Disease (MDRD), and the 2011 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) [1,2,3,4,5,6].
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