Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wesson L (1969) Physiology of the human kidney. Grune & Stratton, New York

    Google Scholar 

  2. Sunder-Plassmann G, Horl WH (2004) A critical appraisal for definition of hyperfiltration. Am J Kidney Dis 43:396

    Article  PubMed  Google Scholar 

  3. Gonçalves-Pereira J, Póvoa P (2011) Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams. Crit Care 15:R206

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lipman J, Wallis SC, Boots RJ (2003) Cefepime versus cefpirome: the importance of creatinine clearance. Anesth Analg 97:1149–1154

    Article  CAS  PubMed  Google Scholar 

  5. Baptista JP, Sousa E, Martins P, Pimentel J (2012) Augmented renal clearance in septic patients and implications for vancomycin optimization. Int J Antimicrob Agents 39:420–423

    Article  CAS  PubMed  Google Scholar 

  6. Conil JM, Georges B, Lavit M, Seguin T et al (2007) Pharmacokinetics of ceftazidime and cefepime in burn patients: the importance of age and creatinine clearance. Int J Clin Pharmacol Ther 45:529–538

    Article  CAS  PubMed  Google Scholar 

  7. De Paepe P, Belpaire FM, Buylaert WA (2002) Pharmacokinetic and pharmacodynamic considerations when treating patients with sepsis and septic shock. Clin Pharmacokinet 41:1135–1151

    Article  PubMed  Google Scholar 

  8. Baptista JP, Udy AA, Sousa E, Pimentel J, Wang L, Roberts JA, Lipman J (2011) A comparison of estimates of glomerular filtration in critically ill patients with augmented renal clearance. Crit Care 15:R139

    Article  PubMed Central  PubMed  Google Scholar 

  9. Grootaert V, Willems L, Debaveye Y, Meyfroidt G, Spriet I (2012) Augmented renal clearance in the critically ill: how to assess kidney function. Ann Pharmacother 46:952–959

    Article  Google Scholar 

  10. Poggio ED, Nef PC, Wang X, Greene T, Van Lente F, Dennis VW, Hall PM (2005) Performance of the Cockcroft–Gault and modification of diet in renal disease equations in estimating GFR in ill hospitalized patients. Am J Kidney Dis 46:242–252

    Article  PubMed  Google Scholar 

  11. Lipman J, Udy AA, Roberts JA (2011) Do we understand the impact of altered physiology, consequent interventions and resultant clinical scenarios in the intensive care unit? The antibiotic story. Anaesth Intensive Care 39:999–1000

    CAS  PubMed  Google Scholar 

  12. Conil JM, Georges B, Fourcade O et al (2007) Assessment of renal function in clinical practice at the bedside of burn patients. Br J Clin Pharmacol 63:583–594

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  14. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130:461–470

    Article  CAS  Google Scholar 

  15. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed Central  PubMed  Google Scholar 

  16. KDOQI (2007) Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 49:S12–S154

    Article  Google Scholar 

  17. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31

    Article  PubMed Central  PubMed  Google Scholar 

  18. Herrera-Gutiérrez ME, Seller-Pérez G, Maynar-Moliner J, Sánchez-Izquierdo Riera JÁ (2012) Variability in renal dysfunction defining criteria and detection methods in intensive care units: are the international consensus criteria used for diagnosing renal dysfunction? Med Intensiva 36:264–269

    Article  PubMed  Google Scholar 

  19. Hoste EA, Damen J, Vanholder RC, Lameire NH, Delanghe JR, Van den Hauwe K et al (2005) Assessment of renal function in recently admitted critically ill patients with normal serum creatinine. Nephrol Dial Transpl 20:747–753

    Article  CAS  Google Scholar 

  20. Spinler SA, Nawarskas JJ, Boyce EG, Connors JE, Charland SL, Goldfarb S (1998) Predictive performance of ten equations for estimating creatinine clearance in cardiac patients. Iohexol cooperative study group. Ann Pharmacother 32:1275–1283

    Article  CAS  PubMed  Google Scholar 

  21. Snider RD, Kruse JA, Bander JJ, Dunn GH (1995) Accuracy of estimated creatinine clearance in obese patients with stable renal function in the intensive care unit. Pharmacotherapy 15:747–753

    CAS  PubMed  Google Scholar 

  22. Seller-Pérez G, Herrera-Gutiérrez ME, Banderas-Bravo E, Olalla-Sánchez R, Lozano-Sáez R, Quesada-García G (2010) Concordance in critical patients between the equations designed for the calculation of glomerular filtration rate and 24-hour creatinine clearance. Med Intensiva 34:294–302

    Article  PubMed  Google Scholar 

  23. Robert S, Zarowitz BJ, Peterson EL, Dumler F (1993) Predictability of creatinine clearance estimates in critically ill patients. Crit Care Med 21:1487–1495

    Article  CAS  PubMed  Google Scholar 

  24. Bouchard J, Macedo E, Soroko S, Chertow GM, Himmelfarb J, Ikizler TA et al (2010) Comparison of methods for estimating glomerular filtration rate in critically ill patients with acute kidney injury. Nephrol Dial Transpl 25:102–107

    Article  Google Scholar 

  25. Bragadottir G, Redfors B, Ricksten SV (2013) Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury—true GFR versus urinary creatinine clearance and estimating equations. Crit Care 17:R108. doi:10.1186/cc12777

    Article  PubMed  Google Scholar 

  26. Fuster-Lluch O, Gerónimo-Pardo M, Peyró-García R (2008) Glomerular hyperfiltration and albuminuria in critically ill patients. Anaesth Intensive Care 36:674–680

    CAS  PubMed  Google Scholar 

  27. Udy A, Boots R, Senthuran S, Stuart J, Deans R, Lassig-Smith M et al (2010) Augmented creatinine clearance in traumatic brain injury. Anesth Analg 111:1505–1510

    Article  CAS  PubMed  Google Scholar 

  28. Udy AA, Roberts JA, Boots RJ, Paterson DL, Lipman J (2010) Augmented renal clearance: implications for antimicrobial dosing in the critically ill. Clin Pharmacokinet 49:1–16

    Article  CAS  PubMed  Google Scholar 

  29. Hayashi Y, Lipman J, Udy AA, Ng M, McWhinney B, Ungerer J et al (2013) β-Lactam therapeutic drug monitoring in the critically ill: optimising drug exposure in patients with fluctuating renal function and hypoalbuminaemia. Int J Antimicrob Agents 41:162–166

    Article  CAS  PubMed  Google Scholar 

  30. Udy AA, Varghese JM, Altukroni M et al (2012) Subtherapeutic initial β-lactam concentrations in select critically ill patients: association between augmented renal clearance and low trough drug concentrations. Chest 142:30–39

    Article  CAS  PubMed  Google Scholar 

  31. Cherry RA, Eachempati SR, Hydo L, Barie PS (2002) Accuracy of short-duration creatinine clearance determinations in predicting 24-hour creatinine clearance in critically ill and injured patients. J Trauma 53:267–271

    Article  CAS  PubMed  Google Scholar 

  32. Davis GA, Chandler MH (1996) Comparison of creatinine clearance estimation methods in patients with trauma. Am J Health Syst Pharm 53:1028–1032

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Centro Hospitalar Universitário Coimbra, Coimbra, Portugal

    João Pedro Baptista, Marta Neves, Luis Rodrigues, Luísa Teixeira, João Pinho & Jorge Pimentel

Authors
  1. João Pedro Baptista
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marta Neves
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luis Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luísa Teixeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. João Pinho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jorge Pimentel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to João Pedro Baptista.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baptista, J.P., Neves, M., Rodrigues, L. et al. Accuracy of the estimation of glomerular filtration rate within a population of critically ill patients. J Nephrol 27, 403–410 (2014). https://doi.org/10.1007/s40620-013-0036-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-013-0036-x

Keywords

Search

Navigation