CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSEP research network, Tours, France.
CHR Orléans, Médecine Intensive Réanimation, CRICS-TriggerSEP research network, Orléans, France.
Crit Care Med. 2021 Aug 1;49(8):e761-e770. doi: 10.1097/CCM.0000000000004946.
Static glomerular filtration rate formulas are not suitable for critically ill patients because of nonsteady state glomerular filtration rate and variation in the volume of distribution. Kinetic glomerular filtration rate formulas remain to be evaluated against a gold standard. We assessed the most accurate kinetic glomerular filtration rate formula as compared to iohexol clearance among patients with shock.
Retrospective multicentric study.
Three French ICUs in tertiary teaching hospitals.
Fifty-seven patients within the first 12 hours of shock.
On day 1, we compared kinetic glomerular filtration rate formulas with iohexol clearance, with or without creatinine concentration correction according to changes in volume of distribution and ideal body weight. We analyzed three static glomerular filtration rate formulas (Cockcroft and Gault, modification of diet in renal disease, and Chronic Kidney Disease-Epidemiology Collaboration), urinary creatinine clearance, and seven kinetic glomerular filtration rate formulas (Jelliffe, Chen, Chiou and Hsu, Moran and Myers, Yashiro, Seelhammer, and Brater). We evaluated 33 variants of these formulas after applying corrective factors. The bias ranged from 12 to 47 mL/min/1.73 m2. Only the Yashiro equation had a lower bias than urinary creatinine clearance before applying corrective factors (15 vs 20 mL/min/1.73 m2). The corrected Moran and Myers formula had the best mean bias, 12 mL/min/1.73 m2, but wide limits of agreement (-50 to 73). The corrected Moran and Myers value was within 30% of iohexol-clearance-measured glomerular filtration rate for 27 patients (47.4%) and was within 10% for nine patients (15.8%); other formulas showed even worse accuracy.
Kinetic glomerular filtration rate equations are not accurate enough for glomerular filtration rate estimation in the first hours of shock, when glomerular filtration rate is greatly decreased. They can both under- or overestimate glomerular filtration rate, with a trend to overestimation. Applying corrective factors to creatinine concentration or volume of distribution did not improve accuracy sufficiently to make these formulas reliable. Clinicians should not use kinetic glomerular filtration rate equations to estimate glomerular filtration rate in patients with shock.
由于肾小球滤过率处于非稳定状态和分布容积的变化，静态肾小球滤过率公式不适合用于危重症患者。动力学肾小球滤过率公式仍需与金标准进行比较。我们评估了在休克患者中，与碘海醇清除率相比，最准确的动力学肾小球滤过率公式。
回顾性多中心研究。
三家法国三级教学医院的重症监护病房。
休克后 12 小时内的 57 名患者。
在第 1 天，我们比较了动力学肾小球滤过率公式与碘海醇清除率，包括根据分布容积和理想体重的变化进行肌酐浓度校正和不校正的情况。我们分析了三个静态肾小球滤过率公式（Cockcroft 和 Gault、改良肾脏病饮食、慢性肾脏病-流行病学合作）、尿肌酐清除率和七个动力学肾小球滤过率公式（Jelliffe、Chen、Chiou 和 Hsu、Moran 和 Myers、Yashiro、Seelhammer 和 Brater）。在应用校正因子后，我们评估了这些公式的 33 个变体。偏倚范围为 12 至 47 mL/min/1.73 m2。只有在应用校正因子之前，Yashiro 方程的偏倚低于尿肌酐清除率（15 比 20 mL/min/1.73 m2）。校正后的 Moran 和 Myers 公式具有最佳的平均偏倚，为 12 mL/min/1.73 m2，但一致性界限较宽（-50 至 73）。校正后的 Moran 和 Myers 值与碘海醇清除率测量的肾小球滤过率相差 30%以内的有 27 名患者（47.4%），相差 10%以内的有 9 名患者（15.8%）；其他公式的准确性更差。
在休克的最初几个小时内，当肾小球滤过率大大降低时，动力学肾小球滤过率方程不足以准确估计肾小球滤过率。它们都可能低估或高估肾小球滤过率，且倾向于高估。应用肌酐浓度或分布容积的校正因子并不能显著提高准确性，使其成为可靠的方法。临床医生不应该使用动力学肾小球滤过率方程来估计休克患者的肾小球滤过率。
