Hoste Eric A J, Damen Jorn, Vanholder Raymond C, Lameire Norbert H, Delanghe Joris R, Van den Hauwe Kristof, Colardyn Francis A
Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
Nephrol Dial Transplant. 2005 Apr;20(4):747-53. doi: 10.1093/ndt/gfh707. Epub 2005 Feb 8.
Detection of renal dysfunction is important in critically ill patients, and in daily practice, serum creatinine is used most often. Other tools allowing the evaluation of renal function are the Cockcroft-Gault and MDRD (Modification of Diet in Renal Disease) equations. These parameters may, however, not be optimal for critically ill patients. The present study evaluated the value of a single serum creatinine measurement, within normal limits, and three commonly used prediction equations for assessment of glomerular function (Cockcroft-Gault, MDRD and the simplified MDRD formula), compared with creatinine clearance (Ccr) measured on a 1 h urine collection in an intensive care unit (ICU) population.
This was a prospective observational study. A total of 28 adult patients with a serum creatinine <1.5 mg/dl, within the first week of ICU admission, were included in the study. Renal function was assessed with serum creatinine, timed 1 h urinary Ccr, and the Cockcroft-Gault, MDRD and simplified MDRD equations.
Serum creatinine was in the normal range in all patients. Despite this, measured urinary Ccr was <80 ml/min/1.73 m2 in 13 patients (46.4%), and <60 ml/min/1.73 m2 in seven patients (25%). Urinary creatinine levels were low, especially in patients with low Ccr, suggesting a depressed production of creatinine caused by pronounced muscle loss. Regression analysis and Bland-Altman plots revealed that neither the Cockcroft-Gault formula nor the MDRD equations were specific enough for assessment of renal function.
In recently admitted critically ill patients with normal serum creatinine, serum creatinine had a low sensitivity for detection of renal dysfunction. Furthermore, the Cockcroft-Gault and MDRD equations were not adequate in assessing renal function.
在重症患者中，肾功能障碍的检测至关重要，在日常实践中，血清肌酐是最常用的检测指标。其他用于评估肾功能的工具包括Cockcroft - Gault方程和MDRD（肾脏病饮食改良）方程。然而，这些参数对于重症患者可能并非最佳选择。本研究评估了在正常范围内单次血清肌酐测量值以及三个常用预测方程（Cockcroft - Gault方程、MDRD方程和简化MDRD公式）用于评估肾小球功能的价值，并与在重症监护病房（ICU）人群中通过1小时尿液收集测得的肌酐清除率（Ccr）进行比较。
这是一项前瞻性观察性研究。共有28例成年患者在入住ICU的第一周内被纳入研究，其血清肌酐<1.5 mg/dl。通过血清肌酐、定时1小时尿Ccr以及Cockcroft - Gault方程、MDRD方程和简化MDRD方程评估肾功能。
所有患者的血清肌酐均在正常范围内。尽管如此，13例患者（46.4%）的实测尿Ccr<80 ml/min/1.73 m²，7例患者（25%）的实测尿Ccr<60 ml/min/1.73 m²。尿肌酐水平较低，尤其是Ccr较低的患者，提示因明显的肌肉丢失导致肌酐生成减少。回归分析和Bland - Altman图显示Cockcroft - Gault公式和MDRD方程均不足以特异性地评估肾功能。
在近期入院且血清肌酐正常的重症患者中，血清肌酐对肾功能障碍的检测敏感性较低。此外，Cockcroft - Gault方程和MDRD方程在评估肾功能方面并不充分。
