Kadivarian Sara, Heydarpour Fatemeh, Karimpour Hasanali, Shahbazi Foroud
Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Acute Crit Care. 2022 May;37(2):185-192. doi: 10.4266/acc.2021.01256. Epub 2022 Apr 22.
Acute kidney injury (AKI) commonly occurs in critically ill patients. Estimation of renal function and antibiotics dose adjustment in patients with AKI is a challenging issue.
Urinary creatinine clearance was measured in a 6-hour urine collection from patients with acute kidney injuries. The correlations between different formulas including the modified Cockcroft-Gault, modification of diet in renal disease, chronic kidney disease-epidemiology collaboration, Jelliffe, kinetic-glomerular filtration rate (GFR), Brater, and Chiou formulas were considered. The pattern of the prescribed antimicrobial agents was also compared with the patterns in the available resources.
Ninety-five patients with acute kidney injuries were included in the research. The mean age of the participants was 63.11±17.58 years old. The most patients (77.89%) were in stage 1 of AKI according to the Acute Kidney Injury Network criteria, followed by stage 2 (14.73%) and stage 3 (7.36), respectively. None of the formulations had a high or very high correlation with the measured creatinine clearance. In stage 1, Chiou (r=0.26), and in stage 2 and 3, kinetic-GFR (r=0.76 and r=0.37) had the highest correlation coefficient. Antibiotic over- and under-dosing were frequently observed in the study.
The results showed that none of the static methods can predict the measured creatinine clearance in the critically ill patients. The dynamic methods such as kinetic-GFR can be helpful for patients who do not receive diuretics and vasopressors. Further studies are needed to confirm our results.
急性肾损伤（AKI）常见于危重症患者。对AKI患者的肾功能评估及抗生素剂量调整是一个具有挑战性的问题。
对急性肾损伤患者进行6小时尿液收集，测量尿肌酐清除率。考虑了不同公式之间的相关性，包括改良的Cockcroft-Gault公式、肾脏病饮食改良公式、慢性肾脏病流行病学合作公式、Jelliffe公式、动态肾小球滤过率（GFR）公式、Brater公式和Chiou公式。还将所开具抗菌药物的模式与现有资源中的模式进行了比较。
95例急性肾损伤患者纳入研究。参与者的平均年龄为63.11±17.58岁。根据急性肾损伤网络标准，大多数患者（77.89%）处于AKI 1期，其次分别为2期（14.73%）和3期（7.36%）。没有一个公式与测得的肌酐清除率具有高度或非常高的相关性。在1期，Chiou公式（r = 0.26），在2期和3期，动态GFR公式（r = 0.76和r = 0.37）具有最高的相关系数。研究中经常观察到抗生素用药过量和不足的情况。
结果表明，没有一种静态方法能够预测危重症患者测得的肌酐清除率。动态方法如动态GFR对未接受利尿剂和血管升压药的患者可能有帮助。需要进一步研究来证实我们的结果。
