A comparison of CKD-EPI estimated glomerular filtration rate and measured creatinine clearance in recently admitted critically ill patients with normal plasma creatinine concentrations

摘要

Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) has been widely integrated into clinical practice. Although useful in screening for CKD, its’ application in critically ill patients with normal plasma creatinine concentrations remains uncertain. The aim of this study was to assess the performance of CKD-EPI eGFR in comparison to creatinine clearance (CL_CR) in this setting. Methods This prospective observational study was performed in a tertiary level, university affiliated intensive care unit (ICU). Study participants had to have an expected ICU length of stay?>?24?hours, a plasma creatinine concentration?CR. Data capture occurred within 48?hours of admission. Results One hundred and ten patients (n?=?110) were enrolled in the study. 63.6% were male, the mean age was 50.9 (16.9) years, 57.3% received invasive mechanical ventilation, and 30% required vasopressor support. The mean CL_CR was 125 (45.1) ml/min/1.73?m2, compared to a CKD-EPI eGFR of 101 (23.7) ml/min/1.73?m2 (P?2). In those patients with a CKD-EPI eGFR between 60–119?ml/min/1.73?m2 (n?=?77), 41.6% displayed augmented renal clearance (CL_CR?≥?130?ml/min/1.73?m2), while 7.8% had a CL_CR?2. Conclusions These data suggest CKD-EPI eGFR and measured CL_CR produce significantly disparate results when estimating renal function in this population. Clinicians should consider carefully which value they employ in clinical practice, particularly drug dose modification.