Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study.

摘要

OBJECTIVE: To estimate the usefulness of 2-h creatinine clearance (CrCl) in the ICU and define variables that may reduce agreement. DESIGN: Prospective study. SETTING: Polyvalent ICU of a university hospital. PATIENTS: 359[Symbol: see text]patients. INTERVENTIONS: We compared 24-h CrCl (CrCl-24h), as the standard measure, with 2-h CrCl (CrCl-2h) (at the start of the period) and the Cockroft-Gault equation (Ck-G). MEASUREMENTS AND RESULTS: The 2-h sample was lost in two patients (0.6%) and the 24-h sample was lost in 50[Symbol: see text]patients (13.9%). The mean Ck-G was 87.4[Symbol: see text]+/-[Symbol: see text]3.05, with CrCl-2h 109.2[Symbol: see text]+/-[Symbol: see text]4.46 and CrCl-24h 100.9[Symbol: see text]+/-[Symbol: see text]4.21[Symbol: see text]ml/min/1.73[Symbol: see text]m(2) (r (2) of 0.88 for CrCl-2h and 0.84 for Ck-G). The differences from ClCr-24h were 21.8[Symbol: see text]+/-[Symbol: see text]3.3 ([Symbol: see text]p[Symbol: see text]<[Symbol: see text]0.001) for the Ck-G and 8.3[Symbol: see text]+/-[Symbol: see text]2.6 ([Symbol: see text]p[Symbol: see text]<[Symbol: see text]0.05) for CrCl-2h ([Symbol: see text]p[Symbol: see text]<[Symbol: see text]0.05). In the subgroup of patients with CrCl-24h[Symbol: see text]<[Symbol: see text]100[Symbol: see text]ml/min/1.73[Symbol: see text]m(2), the CrCl-24h value was 52.9[Symbol: see text]+/-[Symbol: see text]2.71 vs. 51.6[Symbol: see text]+/-[Symbol: see text]2.14 for CrCl-2h ([Symbol: see text]p[Symbol: see text]=[Symbol: see text]ns) and 57.6[Symbol: see text]+/-[Symbol: see text]2.56 ([Symbol: see text]p[Symbol: see text]<[Symbol: see text]0.001) for the Ck-G. Patients with CrCl[Symbol: see text]<[Symbol: see text]100[Symbol: see text]ml/min only showed variability in hyperglycemia during the 24-h period. CONCLUSIONS: In intensive care patients, 24-h CrCl results in a large proportion of non-valid determinations, even under conditions of close monitoring. Two-hour CrCl is an adequate substitute, even in patients who are unstable or who have irregular diuresis where a 24-h collection is impossible. The Cockroft-Gault equation seems less useful in this setting.