应用碘海醇血浆清除率评估合并急性肾损伤肌酐清除率增高的危重症患者肾小球滤过率：单中心回顾性研究。
Evaluation of glomerular filtration rate using iohexol plasma clearance in critically ill patients with augmented renal creatinine clearance: A single-centre retrospective study.
机构信息
From the Department of Anesthesiology and Critical care, Hôpital Lariboisière, DMU Parabol, FHU PROMICE, APHP.Nord (M-C, D-H, P-S, R-B, A-M, BG-C), Department of Interventional Neuroradiology, Hopital Lariboisière (MA-L), EA 7334 REMES (MA-L), Functional Exploration Department, Hôpital Necker, APHP.Centre, Université de Paris (D-P), Inserm U1151 (D-P), Department of Physiology, Hôpital Bichat, APHP.Nord (N-T), Inserm U1149 (N-T) and Inserm U942, Université de Paris, Paris, France (A-M, BG-C).
出版信息
Eur J Anaesthesiol. 2021 Jun 1;38(6):652-658. doi: 10.1097/EJA.0000000000001501.
BACKGROUND
Augmented renal creatinine clearance (ARC) (≥130 ml min-1 1.73 m-2) is frequent in intensive care unit (ICU) patients and may impact patient outcome.
OBJECTIVES
To compare glomerular filtration rate (GFR) measured with iohexol plasma clearance and creatinine clearance in critically ill patients with augmented renal clearance.
DESIGN
Single-centre, retrospective study.
SETTING
French University Hospital ICU from November 2016 to May 2019.
PATIENTS
Adult patients with augmented renal clearance who had a measurement of iohexol plasma clearance.
MAIN OUTCOME MEASURE
Agreement between 6 h creatinine clearance (6 h CrCl) and iohexol plasma clearance (GFRio).
RESULTS
Twenty-nine patients were included. The median 6 h creatinine clearance was 195 [interquartile range (IQR) 162 to 251] ml min-1 1.73 m-2 and iohexol clearance was 133 [117 to 153] ml min-1 1.73 m-2. Sixteen patients (55%) had hyperfiltration (clearance >130 ml min-1 1.73 m-2) measured with iohexol clearance. Mean bias between iohexol and creatinine clearance was -80 [limits of agreement (LoA) -216 to 56 ml min-1 1.73 m-2]. For Cockcroft and Gault Modification of Diet in Renal Disease equation (MDRD), Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) formulae, mean biases were, respectively -27 (LoA -99 to 45), -14 (LoA -86 to 59) and 15 (LoA -33 to 64) ml min-1 1.73 m-2.
CONCLUSION
In the present study, we found that in patients with augmented renal creatinine clearance, half of the patients do not have hyperfiltration using iohexol clearance measurements. We observed an important bias between 6 h CrCl and GFRio with large LoA. In critically patients with ARC, 6 h CrCl does not reliably estimate GFR and 6 h CrCl nearly systematically overestimates renal function. Comparison of creatinine-based GFR estimations and GFRio show acceptable bias but wide LoA.
背景
增强型肾肌酐清除率（ARC）（≥130ml/min/1.73m2）在重症监护病房（ICU）患者中很常见，可能会影响患者的预后。
目的
比较使用碘海醇血浆清除率和肌酐清除率测量的危重病患者中肾小球滤过率（GFR）。
设计
单中心、回顾性研究。
地点
法国大学医院 ICU，2016 年 11 月至 2019 年 5 月。
患者
ARC 患者，有碘海醇血浆清除率测量值。
主要观察指标
6 小时肌酐清除率（6hCrCl）与碘海醇血浆清除率（GFRio）的一致性。
结果
共纳入 29 例患者。中位 6hCrCl 为 195[四分位距（IQR）162 至 251]ml/min/1.73m2，碘海醇清除率为 133[117 至 153]ml/min/1.73m2。16 例（55%）患者的清除率（清除率>130ml/min/1.73m2）用碘海醇清除率测量值偏高。碘海醇和肌酐清除率之间的平均偏差为-80[允许误差（LoA）-216 至 56ml/min/1.73m2]。对于 Cockcroft 和 Gault 改良肾脏病饮食公式（MDRD）、慢性肾脏病流行病学合作公式（CKD-EPI），平均偏差分别为-27（LoA-99 至 45）、-14（LoA-86 至 59）和 15（LoA-33 至 64）ml/min/1.73m2。
结论
在本研究中，我们发现，在 ARC 患者中，一半的患者使用碘海醇清除率测量值没有发生高滤过。我们观察到 6hCrCl 和 GFRio 之间存在重要的偏差，且允许误差较大。在 ARC 危重病患者中，6hCrCl 不能可靠地估计 GFR，并且 6hCrCl 几乎系统地高估了肾功能。基于肌酐的 GFR 估计值与 GFRio 的比较显示出可接受的偏差，但允许误差较大。
Zotero 插件