Division of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, 115E Beard Hall, Campus, Box 7574, Chapel Hill, NC, 27599-7574, USA.
Neurocrit Care. 2020 Jun;32(3):828-835. doi: 10.1007/s12028-019-00854-w.
Obtaining an accurate estimation of renal function is germane to optimizing care in critically ill patients. However, there is no consensus on the most accurate renal function assessment to utilize in this patient population, particularly in aneurysmal subarachnoid hemorrhage (aSAH) patients. Thus, the objective of this observational study was to determine the comparability of renal function equations to body surface area (BSA)-adjusted 8-h creatinine clearance (CrCl) in aSAH patients.
A PubMed search investigated the applicability of various renal function equations in critically ill patient populations. A subset of these equations was compared to BSA-adjusted 8-h CrCl from a previous study with aSAH patients with no evidence of renal dysfunction (admission serum creatinine < 1.5 mg/dL) and no history of chronic kidney disease. Area-under-the-curve (AUC) calculations were completed using serial laboratory measurements to validate preliminary findings.
A total of 14 renal function equations were identified with seven carried forward for further analysis based upon a priori criteria. Seven equations were excluded for various reasons, including lack of available clinical data, redundancy with other equations, and dissimilar patient populations to this study. When directly compared to the BSA-adjusted 8-h CrCl, only the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault equations were not statistically significantly different (P = 0.0886 and P = 0.4805, respectively); all other equations were statistically significantly different (P < 0.0001). Additionally, only 52% and 44% of patients had average values within 20% of the BSA-adjusted 8-h CrCl using the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault equations, respectively. Finally, the AUC calculations corroborated the preliminary findings with similar results in statistical testing for the Cockcroft-Gault and BSA-adjusted Cockcroft-Gault (P = 0.6300 and P = 0.1513, respectively).
The Cockcroft-Gault equation may be the best renal function equation to assess in critically ill patients diagnosed with aSAH. However, accuracy and consistency in assessing renal function when compared to the BSA-adjusted 8-h CrCl were lacking. Thus, this study suggests the BSA-adjusted 8-h CrCl may be the most appropriate assessment of renal function in patients with aSAH.
准确评估肾功能对于危重症患者的治疗至关重要。然而，目前尚无共识确定最适合该人群的肾功能评估方法，尤其是在动脉瘤性蛛网膜下腔出血（aSAH）患者中。因此，本观察性研究的目的是确定肾功能方程与身体表面积（BSA）校正的 8 小时肌酐清除率（CrCl）在 aSAH 患者中的可比性。
通过 PubMed 搜索，研究了各种肾功能方程在危重症患者中的适用性。从先前一项无肾功能障碍（入院时血清肌酐<1.5mg/dL）和无慢性肾脏病病史的 aSAH 患者的研究中，选择了其中一部分方程，并与 BSA 校正的 8 小时 CrCl 进行比较。使用连续实验室测量进行曲线下面积（AUC）计算，以验证初步发现。
共确定了 14 种肾功能方程，其中 7 种根据预设标准进行了进一步分析。由于各种原因排除了 7 种方程，包括缺乏临床数据、与其他方程重复以及与本研究患者人群不同。与 BSA 校正的 8 小时 CrCl 直接比较时，只有 Cockcroft-Gault 和 BSA 校正的 Cockcroft-Gault 方程无统计学差异（P=0.0886 和 P=0.4805），其他所有方程均有统计学差异（P<0.0001）。此外，仅分别使用 Cockcroft-Gault 和 BSA 校正的 Cockcroft-Gault 方程时，有 52%和 44%的患者的平均值在 BSA 校正的 8 小时 CrCl 的 20%以内。最后，AUC 计算结果与初步发现一致，在对 Cockcroft-Gault 和 BSA 校正的 Cockcroft-Gault 方程进行统计学检验时，结果相似（P=0.6300 和 P=0.1513）。
Cockcroft-Gault 方程可能是评估诊断为 aSAH 的危重症患者肾功能的最佳方程。然而，与 BSA 校正的 8 小时 CrCl 相比，评估肾功能的准确性和一致性均欠佳。因此，本研究提示 BSA 校正的 8 小时 CrCl 可能是评估 aSAH 患者肾功能的最适当方法。
