Screening of patients with augmented renal clearance in ICU: taking into account
the CKD-EPI equation, the age, and the cause of admission
#MMPMID26667819
Ruiz S
; Minville V
; Asehnoune K
; Virtos M
; Georges B
; Fourcade O
; Conil JM
Ann Intensive Care
2015[Dec]; 5
(1
): 49
PMID26667819
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BACKGROUND: 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 m(2)), 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.
METHODS: We 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. RESULTS: In 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 m(2). CONCLUSIONS: In 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.
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