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The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute kidney injury in the ICU

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Abstract

Purpose

To quantify the error in evaluating recovery from acute kidney injury (AKI) with estimated GFR (eGFR) in relation to ICU stay.

Methods

Secondary analysis performed on the database of the EPaNIC trial. In a cohort of patients who developed AKI during ICU stay we compared eGFR with measured creatinine clearance (Clcr) at ICU discharge. Recovery of kidney function was assessed by comparison with baseline eGFR and the accuracy of eGFR to detect “potential CKD status” defined by Clcr was quantified. The same analysis was performed in subgroups with different ICU stay. Multivariate regression was performed to determine independent predictors of the eGFR–Clcr difference.

Results

A total of 757 patients were included. The bias (limits of agreement (LOA)) between eGFR and Clcr at ICU discharge related to ICU stay, increasing from +1.3 (−37.4/+40) ml/min/1.73 m2 in patients with short stay to +34.7 (−54.4/+123.8) ml/min/1.73 m2 in patients with ICU stay of more than 14 days. This resulted in a significantly different incidence of complete recovery with the two evaluation methods and reduced sensitivity to detect “potential CKD status” with eGFR in patients with prolonged ICU stay. Independent predictors of the bias included creatinine excretion on the last day in ICU, baseline eGFR, ICU stay, gender, and age.

Conclusion

Compared to Clcr, discharge eGFR results in overestimation of renal recovery in patients with prolonged ICU stay and in reduced accuracy of “CKD staging”. Since age, gender and race do not change during ICU stay the same conclusion can be drawn with regard to plasma creatinine.

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Conflicts of interest

The authors declare that they have no conflicts of interest related to the subject of the study. GVdB, via the University of Leuven, receives structural research financing via the Methusalem program, funded by the Flemish Government (METH08/07) and holds an ERC Advanced Grant (AdvG-2012-321670) from the Ideas program of the EU FP7.

Ethical standard

This study is a secondary analysis of the EPaNIC trial, for which written informed consent was obtained from all patients or their designated representatives. The protocol of the EPaNIC trial was approved by the institutional review board of the participating centers and by the Belgian authorities.

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Authors and Affiliations

  1. Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven University, Herestraat 49, 3000, Leuven, Belgium

    M. Schetz, J. Gunst & G. Van den Berghe

Authors
  1. M. Schetz
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  2. J. Gunst
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  3. G. Van den Berghe
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Corresponding author

Correspondence to M. Schetz.

Additional information

Take home message: In patients with prolonged ICU stay, recovery of AKI is significantly overestimated when assessed with eGFR.

Electronic supplementary material

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134_2014_3487_MOESM1_ESM.docx

Supplementary material 1 (DOCX 25 kb) Fig. 1 electronic supplement. Bland–Altman analysis of the difference between Clcr and eGFR at ICU discharge a in all no-AKI patients, b in no-AKI patients with ICU stay less than 8 days, c in no-AKI patients with ICU stay between 8 and 14 days, d in no-AKI patients with ICU stay longer than 14 days. The continuous line represents bias and the dashed lines the limits of agreement

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Schetz, M., Gunst, J. & Van den Berghe, G. The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute kidney injury in the ICU. Intensive Care Med 40, 1709–1717 (2014). https://doi.org/10.1007/s00134-014-3487-1

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  • DOI: https://doi.org/10.1007/s00134-014-3487-1

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