Aslan Semir, Demirpolat Eren, Gundogan Kursat, Yuksel Recep Civan, Temel Sahin, Sungur Murat
Faculty of Pharmacy, Department of Clinical Pharmacy, Erciyes University, Kayseri, Turkey.
Faculty of Pharmacy, Department of Pharmacology, Erciyes University, Kayseri, Turkey.
Eur J Clin Pharmacol. 2025 Aug 18. doi: 10.1007/s00228-025-03908-5.
Acute kidney injury (AKI) is a prevalent complication in critically care, affecting prognosis and management. Standard formulas for estimating glomerular filtration rate (GFR), such as CKD-EPI and MDRD, are frequently used; accuracy in AKI is limited due to fluctuating creatinine. This study aimed to evaluate the agreement between standard GFR and kinetic-GFR formulas in AKI patients and to assess the impact on antibiotic dosing.
In this prospective, observational study conducted at Erciyes University Hospital, 100 patients with AKI were enrolled. GFR was estimated using CKD-EPI, MDRD, and kinetic-GFR formulas, including volume-adjusted kinetic formulas. Agreement between formulas was analyzed using Kappa coefficient.
Statistically significant but imperfect agreement was observed between kinetic and standard formulas (CKD-EPI: κ = 0.592 ± 0.026, p < 0.001; MDRD: κ = 0.649 ± 0.025, p < 0.001). Approximately 28-30% of follow-up days revealed category mismatches between standard and kinetic formulas. 47% of the mismatches of CKD-EPI vs ki-CKD-EPI, and 31% for MDRD vs ki-MDRD occurred on day 2. Volume-adjusted kinetic formulas increased the mismatch rate, with CKD-EPI increasing from 28.5% to 30.6% (p < 0.001) and MDRD from 24.4% to 27.2% (p < 0.001). Significant dose adjustments were required when kinetic-GFR was used, particularly for nephrotoxic antibiotics.
The use of kinetic-GFR formulas improves the accuracy of GFR estimation in AKI, especially in the early stages, and may lead to more appropriate antibiotic dosing. However, further studies are needed to fully understand the clinical implications, especially regarding drug levels and patient outcomes.
急性肾损伤（AKI）是重症监护中常见的并发症，影响预后和治疗管理。常用标准公式估算肾小球滤过率（GFR），如慢性肾脏病流行病学协作组（CKD-EPI）公式和肾脏病饮食调整（MDRD）公式；由于肌酐波动，这些公式在AKI中的准确性有限。本研究旨在评估AKI患者中标准GFR公式与动态GFR公式之间的一致性，并评估其对抗生素给药的影响。
在埃尔西耶斯大学医院进行的这项前瞻性观察研究中，纳入了100例AKI患者。使用CKD-EPI、MDRD和动态GFR公式估算GFR，包括体积校正动态公式。使用Kappa系数分析公式之间的一致性。
动态公式与标准公式之间存在统计学上显著但并不完美的一致性（CKD-EPI：κ = 0.592 ± 0.026，p < 0.001；MDRD：κ = 0.649 ± 0.025，p < 0.001）。在大约28%-30%的随访日中，标准公式与动态公式之间出现类别不匹配。CKD-EPI与ki-CKD-EPI之间47%的不匹配以及MDRD与ki-MDRD之间31%的不匹配发生在第2天。体积校正动态公式增加了不匹配率，CKD-EPI从28.5%增加到30.6%（p < 0.001），MDRD从24.4%增加到27.2%（p < 0.001）。使用动态GFR公式时需要进行显著的剂量调整，尤其是对于肾毒性抗生素。
使用动态GFR公式可提高AKI中GFR估算的准确性，尤其是在早期阶段，并且可能导致更合适的抗生素给药。然而，需要进一步研究以充分了解其临床意义，特别是关于药物水平和患者预后方面。
