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Journal of Nephrology

, Volume 27, Issue 4, pp 403–410 | Cite as

Accuracy of the estimation of glomerular filtration rate within a population of critically ill patients

  • João Pedro Baptista
  • Marta Neves
  • Luis Rodrigues
  • Luísa Teixeira
  • João Pinho
  • Jorge Pimentel
Original Article

Abstract

Background

Accuracy of glomerular filtration rate (GFR) estimates has been questioned and several authors recommend routine use of measured renal creatinine clearance (CLCR) as a surrogate of GFR in the intensive care unit (ICU). Our purpose was to compare estimates of GFR using Cockroft–Gault (CG), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease Study (MDRD) equations with 8h-CLCR, within a population of critically ill patients with a wide range of measured CLCR.

Methods

Through a prospective, observational study of 54 patients with normal serum creatinine (sCr) admitted to ICU, daily 8h-CLCR (reference method) and GFR estimates (644 paired samples) were matched and compared. Augmented renal clearance (ARC) was defined as 8h-CLCR >130 ml/min/1.73 m2.

Results

No significant difference was found between mean 8h-CLCR (135.5 ml/min/1.73 m2) and CG equation (135.7 ml/min/1.73 m2), but significant differences (p < 0.01) were found for the MDRD (124.4 ml/min/1.73 m2) and CKD-EPI (107.6 ml/min/1.73 m2) equations. Correlation between 8h-CLCR and all estimates was weak (R = 0.2, 0.19 and 0.34, respectively). We observed poor agreement in terms of precision (40.9, 39.8 and 33.4 %, respectively). Analysing subgroups, we observed that all equations significantly underestimated 8h-CLCR >120 ml/min/1.73 m2 and overestimated 8h-CLCR <120 ml/min/1.73 m2 (p < 0.05). The incidence of ARC patients was 55.6 %.

Conclusions

Estimates of GFR using CG, CKD-EPI and MDRD formulae are flawed in the critically ill with normal sCr, significantly underestimating renal function in those with ARC and overestimating it in those with normal or decreased 8h-CLCR. Globally, the population exhibited ARC on more than half of the ICU admission days.

Keywords

Acute kidney injury Critically ill Augmented renal clearance Prediction equations 

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

40620_2013_36_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 kb)

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Copyright information

© Italian Society of Nephrology 2014

Authors and Affiliations

  • João Pedro Baptista
    • 1
  • Marta Neves
    • 1
  • Luis Rodrigues
    • 1
  • Luísa Teixeira
    • 1
  • João Pinho
    • 1
  • Jorge Pimentel
    • 1
  1. 1.Centro Hospitalar Universitário CoimbraCoimbraPortugal

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