入住 ICU 30 天期间的尿肌酐排泄、肌酐清除率和估计肾小球滤过率的时间过程。

Time courses of urinary creatinine excretion, measured creatinine clearance and estimated glomerular filtration rate over 30 days of ICU admission.

机构信息

Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

Department of Nephrology, University of Groningen, University Medical Center, Groningen, the Netherlands.

出版信息

J Crit Care. 2021 Jun;63:161-166. doi: 10.1016/j.jcrc.2020.09.017. Epub 2020 Sep 24.

DOI:10.1016/j.jcrc.2020.09.017

PMID:32994085

Abstract

PURPOSE

Baseline urinary creatinine excretion (UCE) is associated with ICU outcome, but its time course is not known.

MATERIALS AND METHODS

We determined changes in UCE, plasma creatinine, measured creatinine clearance (mCC) and estimated glomerular filtration (eGFR) in patients with an ICU-stay ≥30d without acute kidney injury stage 3. The Cockcroft-Gault, MDRD (modification of diet in renal disease) and CKD-EPI (chronic kidney disease epidemiology collaboration) equations were used.

RESULTS

In 248 patients with 5143 UCEs hospital mortality was 24%. Over 30d, UCE absolutely decreased in male survivors and non-survivors and female survivors and nonsurvivors by 0.19, 0.16, 0.10 and 0.05 mmol/d/d (all P < 0.001). Relative decreases in UCE were similar in all four groups: 1.3, 1.4, 1.2 and 0.9%/d respectively. Over 30d, mCC remained unchanged, but eGFR rose by 31% (CKD-EPI) and 73% (MDRD) and creatinine clearance estimated by Cockcroft-Gault by 59% (all P < 0.001).

CONCLUSIONS

Over 1 month of ICU stay, UCE declined by ≥1%/d which may correspond to an equivalent decline in muscle mass. These rates of UCE decrease were similar in survivors, non-survivors, males and females underscoring the intransigent nature of this process. In contrast to measured creatinine clearance, estimates of eGFR progressively rose during ICU stay.

摘要

目的

基础尿肌酐排泄量（UCE）与 ICU 预后相关，但目前尚不清楚其时间进程。

材料与方法

我们测定了 ICU 入住时间≥30d 且无急性肾损伤 3 期的患者的 UCE、血浆肌酐、估算的肌酐清除率（mCC）和估计肾小球滤过率（eGFR）的变化。采用 Cockcroft-Gault、MDRD（肾脏病饮食改良研究）和 CKD-EPI（慢性肾脏病流行病学合作）方程。

结果

在 248 例 UCE 检测 5143 次的患者中，住院死亡率为 24%。在 30d 内，男性幸存者和非幸存者以及女性幸存者和非幸存者的 UCE 绝对降低量分别为 0.19、0.16、0.10 和 0.05mmol/d/d（均 P<0.001）。所有 4 组的 UCE 相对降低量相似：分别为 1.3%、1.4%、1.2%和 0.9%/d。在 30d 内，mCC 保持不变，但 eGFR 分别升高 31%（CKD-EPI）、73%（MDRD）和 Cockcroft-Gault 估计的肌酐清除率升高 59%（均 P<0.001）。