Division of Nephrology, Kyoto City Hospital, 1-2, Mibu Higashitakada-cho, Nakagyo-ku, Kyoto 604-8845, Japan.
Clin Exp Nephrol. 2012 Aug;16(4):570-9. doi: 10.1007/s10157-012-0602-x. Epub 2012 Feb 14.
A simple method to calculate estimated creatinine clearance using two serum creatinine concentration (Cr) values in acute kidney injury (AKI) was developed (eCrCl-AKI). We aimed to evaluate its accuracy and to clarify its contribution to the classification of AKI.
We validated the errors in eCrCl-AKI in a simulation study after various reductions in creatinine clearance (CrCl) at various levels of chronic kidney disease (CKD). We compared the eCrCl-AKI-based classification of RIFLE criteria with the Cr-based classification or that proposed by Waikar and Bonventre. The regression equations of eCrCl-AKI on time were determined and Cr values were reconstructed by creatinine kinetics substituting CrCl with eCrCl-AKI in actual patients.
Most errors in eCrCl-AKI were relatively small (from -13.6 to +7.9%) with the exception of two Cr values that straddled the changing trend of Cr. The classification according to RIFLE criteria based on Cr was unstable and did not enable adequate classification, especially in milder reductions of CrCl with advanced CKD. The classification based on eCrCl-AKI was stable and enabled adequate classification. There were good agreements between measured Cr and reconstructed Cr with eCrCl-AKI. The regression equations of eCrCl-AKI revealed changes of renal function that were unexpected only from fluctuations of Cr.
eCrCl-AKI can provide relatively accurate estimates for fluctuating CrCl. eCrCl-AKI enables more stable and earlier classification of AKI than Cr, at least in the simulation study. The more widespread use of eCrCl-AKI in actual clinical settings of AKI is necessary to evaluate this formula.
我们开发了一种使用急性肾损伤（AKI）中两个血清肌酐浓度（Cr）值计算估算肌酐清除率的简单方法（eCrCl-AKI）。我们旨在评估其准确性，并阐明其对 AKI 分类的贡献。
我们在各种慢性肾脏病（CKD）水平下的不同肌酐清除率（CrCl）降低后的模拟研究中验证了 eCrCl-AKI 的误差。我们比较了基于 RIFLE 标准的 eCrCl-AKI 分类与基于 Cr 的分类或 Waikar 和 Bonventre 提出的分类。确定了 eCrCl-AKI 随时间的回归方程，并通过肌酐动力学将 CrCl 替换为 eCrCl-AKI 来重建实际患者的 Cr 值。
除了两个跨越 Cr 变化趋势的 Cr 值外，eCrCl-AKI 的大多数误差相对较小（从-13.6%到+7.9%）。基于 Cr 的 RIFLE 标准分类不稳定，无法进行充分分类，尤其是在 CKD 进展时 CrCl 轻度降低的情况下。基于 eCrCl-AKI 的分类是稳定的，能够进行充分的分类。eCrCl-AKI 与实测 Cr 之间存在良好的一致性。eCrCl-AKI 的回归方程揭示了肾功能的变化，这些变化仅从 Cr 的波动中是无法预料的。
eCrCl-AKI 可以为波动的 CrCl 提供相对准确的估计。eCrCl-AKI 可以比 Cr 更稳定和更早地对 AKI 进行分类，至少在模拟研究中是这样。在 AKI 的实际临床环境中更广泛地使用 eCrCl-AKI 是评估该公式的必要条件。
