Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill

INTRODUCTION Accurate assessment of GFR in ICU patients is very important for institution of supportive therapy, preventive therapy early renal support, drug dosing modification or avoidance of nephrotoxic drugs and modification of drug dosing. Kinetic estimate of GFR (keGFR) takes into account the...

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Main Authors:	Md Ralib, Azrina, Dzaharudin, Fatimah, Ishak, Nuraisyah, Mat Nor, Mohd. Basri
Format:	Conference or Workshop Item
Language:	English
Published:	2017
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/56693/ http://irep.iium.edu.my/56693/26/56693_Comparison%20between%20different%20equations_new.pdf

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spelling	iium-566932017-06-02T02:13:57Z http://irep.iium.edu.my/56693/ Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill Md Ralib, Azrina Dzaharudin, Fatimah Ishak, Nuraisyah Mat Nor, Mohd. Basri R Medicine (General) INTRODUCTION Accurate assessment of GFR in ICU patients is very important for institution of supportive therapy, preventive therapy early renal support, drug dosing modification or avoidance of nephrotoxic drugs and modification of drug dosing. Kinetic estimate of GFR (keGFR) takes into account the changes of creatinine over time, creatinine production rate, and the volume of distribution, hence postulated to be a more accurate estimate of GFR in the acute settings, where there are rapidly changing kidney functions as in the critically ill. We evaluated the association of the keGFR with estimated GFR by conventional method. METHODS This is an interim analysis of single centre, prospective observational study of critically ill patients. The study has been registered with the National Medical Research Register (NMRR-14-1897-21447) and has obtained ethics approval. Inclusion criteria were patients older than 18 years old with sepsis, defined as clinical infection and acute increase in SOFA score>2, and plasma procalcitonin>0.5ng/ml. Plasma creatinine were measured at seven time points, and eGFR were calculated by the Cockcroft-Gault, MDRD, CKD-EPI and keGFR equations. RESULTS Twenty-four patients were recruited so far, of which 10 (41.7%) had AKI. Two patients need dialysis, and one died. Ten patients developed AKI within 24 hours of ICU admission. keGFR strongly correlated with eGFR by CKD-EPI equation (r=0.92, p<0.0001) at all time points in all patients. Whereas, keGFR only moderately correlated with eGFR by MDRD and Cockcroft-Gault equations (r=0.79 and 0.77, respectively). eGFR by MDRD only strongly correlated with keGFR in subcohort of patients with AKI. CONCLUSIONS The new equation, keGFR strongly correlated with the eGFR by the CKD-EPI equation. In the absence of serial plasma creatinine measurement, eGFR can accurately be estimated by the CKD-EPI equation compared to others. Further analysis would involve analysis of the association with urinary creatinine clearance, and plasma Cystatin C. 2017-04 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/56693/26/56693_Comparison%20between%20different%20equations_new.pdf Md Ralib, Azrina and Dzaharudin, Fatimah and Ishak, Nuraisyah and Mat Nor, Mohd. Basri (2017) Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill. In: Malaysian Society of Anaesthesiology Annual Scientific Meeting 2017, 27-30 April 2017, Johor Bahru, Johor. (Unpublished)
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Md Ralib, Azrina Dzaharudin, Fatimah Ishak, Nuraisyah Mat Nor, Mohd. Basri Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill
description	INTRODUCTION Accurate assessment of GFR in ICU patients is very important for institution of supportive therapy, preventive therapy early renal support, drug dosing modification or avoidance of nephrotoxic drugs and modification of drug dosing. Kinetic estimate of GFR (keGFR) takes into account the changes of creatinine over time, creatinine production rate, and the volume of distribution, hence postulated to be a more accurate estimate of GFR in the acute settings, where there are rapidly changing kidney functions as in the critically ill. We evaluated the association of the keGFR with estimated GFR by conventional method. METHODS This is an interim analysis of single centre, prospective observational study of critically ill patients. The study has been registered with the National Medical Research Register (NMRR-14-1897-21447) and has obtained ethics approval. Inclusion criteria were patients older than 18 years old with sepsis, defined as clinical infection and acute increase in SOFA score>2, and plasma procalcitonin>0.5ng/ml. Plasma creatinine were measured at seven time points, and eGFR were calculated by the Cockcroft-Gault, MDRD, CKD-EPI and keGFR equations. RESULTS Twenty-four patients were recruited so far, of which 10 (41.7%) had AKI. Two patients need dialysis, and one died. Ten patients developed AKI within 24 hours of ICU admission. keGFR strongly correlated with eGFR by CKD-EPI equation (r=0.92, p<0.0001) at all time points in all patients. Whereas, keGFR only moderately correlated with eGFR by MDRD and Cockcroft-Gault equations (r=0.79 and 0.77, respectively). eGFR by MDRD only strongly correlated with keGFR in subcohort of patients with AKI. CONCLUSIONS The new equation, keGFR strongly correlated with the eGFR by the CKD-EPI equation. In the absence of serial plasma creatinine measurement, eGFR can accurately be estimated by the CKD-EPI equation compared to others. Further analysis would involve analysis of the association with urinary creatinine clearance, and plasma Cystatin C.
format	Conference or Workshop Item
author	Md Ralib, Azrina Dzaharudin, Fatimah Ishak, Nuraisyah Mat Nor, Mohd. Basri
author_facet	Md Ralib, Azrina Dzaharudin, Fatimah Ishak, Nuraisyah Mat Nor, Mohd. Basri
author_sort	Md Ralib, Azrina
title	Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill
title_short	Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill
title_full	Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill
title_fullStr	Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill
title_full_unstemmed	Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill
title_sort	comparison between different equations for estimating glomerular filtration rate (gfr) with kinetic estimates of gfr in the critically ill
publishDate	2017
url	http://irep.iium.edu.my/56693/ http://irep.iium.edu.my/56693/26/56693_Comparison%20between%20different%20equations_new.pdf
first_indexed	2023-09-18T21:20:02Z
last_indexed	2023-09-18T21:20:02Z
_version_	1777411819940347904

Comparison between different equations for estimating glomerular filtration rate (GFR) with kinetic estimates of GFR in the critically ill

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