Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland.
Laboratory of Nephrology, Department of Medicine and Cell Physiology, University hospital and University of Geneva, Geneva, Switzerland.
Crit Care Med. 2020 Dec;48(12):e1232-e1241. doi: 10.1097/CCM.0000000000004650.
To compare estimated glomerular filtration rate using classical static and kinetic equations with measured glomerular filtration rate assessed by plasma iohexol clearance in a mixed population of critical care patients.
Unselected patients older than 18 and admitted to a general ICU.
Interventional prospective single center study.
Measurement of glomerular filtration rate by the plasma clearance of an IV single dose of iohexol and estimation of glomerular filtration rate with creatinine or cystatin C-based standard and kinetic equations as well as urinary creatinine clearance.
Sixty-three patients were included with a median age of 66 years old. The median measured glomerular filtration rate was 51 mL/min/1.73 m (interquartile range, 19-85 mL/min/1.73 m). All used equations displayed significant biases, high errors, and poor accuracy when compared with measured glomerular filtration rate, overestimating renal function. The highest accuracy and lowest error were observed with cystatin C-based chronic kidney disease epidemiology collaboration equations. Both modification of diet in renal disease and Cockcroft-Gault equations displayed the lowest performance. Kinetic models did not improve performances, except in patients with unstable creatinine levels. Creatinine- but not cystatin C-based estimations largely derived over ICU stay, which appeared more related to sarcopenia than fluid balance. Finally, estimated glomerular filtration rate misclassified patients according to classical glomerular filtration rate categories in approximately half of the studied cases.
All known estimated glomerular filtration rate equations displayed high biases and unacceptable errors when compared with measured glomerular filtration rate in a mixed ICU population, with the lowest performance related to creatinine-based equations compared with cystatin C. In the ICU, we advocate for caution when using creatinine based estimated glomerular filtration rate equations. Drifting of serum creatinine levels over time should also be taken into consideration when assessing renal function in the ICU.
比较经典静态和动力学方程与通过血浆碘海醇清除率评估的混合危重病患者的肾小球滤过率之间的差异。
年龄大于 18 岁且入住综合 ICU 的未选择患者。
干预性前瞻性单中心研究。
通过 IV 单次剂量碘海醇的血浆清除率测量肾小球滤过率，并使用基于肌酐或胱抑素 C 的标准和动力学方程以及尿肌酐清除率估算肾小球滤过率。
共纳入 63 例患者，中位年龄为 66 岁。中位测量肾小球滤过率为 51 mL/min/1.73 m（四分位间距，19-85 mL/min/1.73 m）。与测量肾小球滤过率相比，所有使用的方程均显示出显著的偏差、高误差和准确性差，高估了肾功能。基于胱抑素 C 的慢性肾脏病流行病学合作方程具有最高的准确性和最低的误差。改良肾脏病饮食方程和 Cockcroft-Gault 方程的表现最低。动力学模型除了在肌酐水平不稳定的患者中，并没有改善性能。肌酐而非胱抑素 C 估计值在 ICU 期间大量产生，这似乎与肌肉减少症而不是液体平衡有关。最后，根据经典肾小球滤过率分类，估计肾小球滤过率在大约一半的研究病例中错误分类了患者。
在混合 ICU 人群中，所有已知的估计肾小球滤过率方程与测量肾小球滤过率相比均显示出较高的偏差和不可接受的误差，基于肌酐的方程与基于胱抑素 C 的方程相比性能最低。在 ICU 中，我们建议在使用基于肌酐的估计肾小球滤过率方程时要谨慎。在评估 ICU 中的肾功能时，还应考虑血清肌酐水平随时间的漂移。
