Dinakar Divya, Chandan Garud, Sreedhara Rajanna, Parekh Aashish, Aryamparambil Padmakumar, Sarada Pooja ikPrathapan, Km Ganesh
Critical Care Medicine, St Johns medical college hospital, Bengaluru, Karnataka, India.
Critical Care Medicine, Fortis Hospital Bannerghatta road, Bengaluru, Karnataka, India.
Sci Prog. 2025 Jan-Mar;108(1):368504251315806. doi: 10.1177/00368504251315806.
To study the impact of kinetic glomerular filtration rate (kGFR) on clinical decision making and its implications on drug dosing compared to that of estimated GFR (eGFR) using chronic kidney disease epidemiology collaboration (CKD-EPI) equation in critically ill patients with acute kidney injury (AKI) admitted in a tertiary level intensive care unit (ICU).
Cross-sectional, prospective, observational study design. All patients admitted to Medical ICU, Fortis Hospital, Bangalore with AKI defined as per AKI network (AKIN) criteria. Patients were recruited after approval from the scientific and institutional ethics committee, with written informed consent. Serum creatinine values at admission and further values were noted. GFR was calculated using both formulas (CKD-EPI and kGFR) and documented at all intervals of creatinine sampling. Drugs requiring renal dose modification along with the dosing were documented. Sample size was calculated after a pilot study and a total of 107 patients were analyzed.
Incidence of AKI was 12.84%. The mean (±SD) eGFR was 37.25 (±29.4) and kGFR was 42.5 (±33.2), (-value .003). 70 (65.42%) patients required drug dose change when kGFR was used. Dosing changes from Day 1 to Day 5 are 53/104 (50.9%), 39/81 (48.1%), 12/26 (46.1%), 2/9 (28.5%), 1/2 (50%). Predominant dose changes were for antimicrobials: vancomycin (35.7%), acyclovir (23.1%), and meropenem (23%).
Drug dosing using different methods of GFR calculation showed a difference in the dosing in 65.42% of patients with AKI. Accounting for change in creatinine over time using kinetic GFR may lead to better drug dosing in critically ill patients with AKI.
Our study shows that calculating GFR using kGFR formula instead of CKD-EPI may change drug dosages among patients with AKI admitted in ICU. By replacing conventional GFR estimation formulas with kGFR we may reduce the drug dosing inaccuracies that are currently prevalent in this cohort of patients.
研究在三级重症监护病房（ICU）收治的急性肾损伤（AKI）危重症患者中，与使用慢性肾脏病流行病学协作组（CKD-EPI）方程估算的肾小球滤过率（eGFR）相比，动态肾小球滤过率（kGFR）对临床决策的影响及其对药物剂量的意义。
采用横断面、前瞻性观察性研究设计。所有入住班加罗尔富通医院内科ICU且符合急性肾损伤网络（AKIN）标准定义的AKI患者。经科学和机构伦理委员会批准并获得书面知情同意后招募患者。记录入院时及后续的血清肌酐值。使用两种公式（CKD-EPI和kGFR）计算肾小球滤过率，并在肌酐采样的所有时间点记录。记录需要调整肾剂量的药物及其剂量。在一项初步研究后计算样本量，共分析了107例患者。
AKI的发生率为12.84%。平均（±标准差）eGFR为37.25（±29.4），kGFR为42.5（±33.2），（P值=0.003）。使用kGFR时，70例（65.42%）患者需要改变药物剂量。从第1天到第5天的剂量变化分别为53/104（50.9%）、39/81（48.1%）、12/26（46.1%）、2/9（28.5%）、1/2（50%）。主要的剂量变化是针对抗菌药物：万古霉素（35.7%）、阿昔洛韦（23.1%）和美罗培南（23%）。
使用不同肾小球滤过率计算方法进行药物剂量调整时，65.42%的AKI患者的剂量存在差异。使用动态肾小球滤过率考虑肌酐随时间的变化可能会使AKI危重症患者的药物剂量更合理。
我们的研究表明，在ICU收治的AKI患者中，使用kGFR公式而非CKD-EPI计算肾小球滤过率可能会改变药物剂量。用kGFR取代传统的肾小球滤过率估算公式，我们可能会减少目前该患者群体中普遍存在的药物剂量不准确问题。
