Estimates of glomerular filtration rate in the critically ill with sepsis

Accurate assessment of glomerular filtration rate (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. Kinetic estimate of GFR (keGFR) takes into account the changes of crea...

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Main Authors:	Md Ralib, Azrina, Dzaharudin, Fatimah, Mat Nor, Mohd. Basri
Format:	Article
Language:	English English
Published:	Elsevier BV 2017
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/58074/ http://irep.iium.edu.my/58074/ http://irep.iium.edu.my/58074/1/1-s2.0-S2468024917302723-main.pdf http://irep.iium.edu.my/58074/11/58074_ESTIMATES%20OF%20GLOMERULAR_acceptance%20letter.pdf

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spelling	iium-580742017-08-21T02:59:40Z http://irep.iium.edu.my/58074/ Estimates of glomerular filtration rate in the critically ill with sepsis Md Ralib, Azrina Dzaharudin, Fatimah Mat Nor, Mohd. Basri R Medicine (General) Accurate assessment of glomerular filtration rate (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. 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 setting, where there are rapidly changing kidney functions as in the critically ill. We evaluated the association of the keGFR with estimated GFR (eGFR) by conventional method. Methods This is an interim analysis of a 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 and Cystatin C were measured at seven time points, and eGFR were calculated by the Cockcroft-Gault, MDRD, CKD-EPI, and eGFRCysC and they were compared to their keGFR equations. Results Twenty four patients were recruited so far, of which 10 (41.7%) had AKI. Two patients needed dialysis, and one died. keGFRCr strongly correlated with eGFRCKD-EPI equation in all patients at all time points (all r≥0.76, p<0.0001). On the other hand, keGFRCr only correlated well with eGFRMDRD and eGFRCG in AKI patients but less in patients without AKI. keGFRCysC strongly correlated with eGFRCysC in all patients at all time points (all r≥0.89, p<0.0001) keGFRCr and keGFRCysC were not strongly correlated (min r=0.29) eGFRCKD-EPI distribution had the greatest precision depicted by the narrower SD lines. Similarly, keGFRCysC had higher precision when compared to eGFRCysC. eGFRMDRD and eGFRCG had the least bias depicted by the mean difference nearest to zero. Both eGFRCKD-EPI and eGFRCysC distribution differed significantly from the keGFRCr and keGFRCysC, respectively (Wilcoxon sign rank test, p<0.0001). Conclusions The new equation, keGFR strongly correlated with the eGFR by the CKD-EPI equation with the highest precision. In the absence of serial plasma creatinine measurement, eGFR is best estimated by the CKD-EPI equation. eGFR of Cystatin C also correlated well with its keGFR. Further study would involve analysis of their association with urinary creatinine clearance. Elsevier BV 2017-07-04 Article PeerReviewed application/pdf en http://irep.iium.edu.my/58074/1/1-s2.0-S2468024917302723-main.pdf application/pdf en http://irep.iium.edu.my/58074/11/58074_ESTIMATES%20OF%20GLOMERULAR_acceptance%20letter.pdf Md Ralib, Azrina and Dzaharudin, Fatimah and Mat Nor, Mohd. Basri (2017) Estimates of glomerular filtration rate in the critically ill with sepsis. Kidney International Reports, 2 (4). S33-S34. ISSN 2452-1981 https://doi.org/10.1016/j.ekir.2017.06.108
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Md Ralib, Azrina Dzaharudin, Fatimah Mat Nor, Mohd. Basri Estimates of glomerular filtration rate in the critically ill with sepsis
description	Accurate assessment of glomerular filtration rate (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. 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 setting, where there are rapidly changing kidney functions as in the critically ill. We evaluated the association of the keGFR with estimated GFR (eGFR) by conventional method. Methods This is an interim analysis of a 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 and Cystatin C were measured at seven time points, and eGFR were calculated by the Cockcroft-Gault, MDRD, CKD-EPI, and eGFRCysC and they were compared to their keGFR equations. Results Twenty four patients were recruited so far, of which 10 (41.7%) had AKI. Two patients needed dialysis, and one died. keGFRCr strongly correlated with eGFRCKD-EPI equation in all patients at all time points (all r≥0.76, p<0.0001). On the other hand, keGFRCr only correlated well with eGFRMDRD and eGFRCG in AKI patients but less in patients without AKI. keGFRCysC strongly correlated with eGFRCysC in all patients at all time points (all r≥0.89, p<0.0001) keGFRCr and keGFRCysC were not strongly correlated (min r=0.29) eGFRCKD-EPI distribution had the greatest precision depicted by the narrower SD lines. Similarly, keGFRCysC had higher precision when compared to eGFRCysC. eGFRMDRD and eGFRCG had the least bias depicted by the mean difference nearest to zero. Both eGFRCKD-EPI and eGFRCysC distribution differed significantly from the keGFRCr and keGFRCysC, respectively (Wilcoxon sign rank test, p<0.0001). Conclusions The new equation, keGFR strongly correlated with the eGFR by the CKD-EPI equation with the highest precision. In the absence of serial plasma creatinine measurement, eGFR is best estimated by the CKD-EPI equation. eGFR of Cystatin C also correlated well with its keGFR. Further study would involve analysis of their association with urinary creatinine clearance.
format	Article
author	Md Ralib, Azrina Dzaharudin, Fatimah Mat Nor, Mohd. Basri
author_facet	Md Ralib, Azrina Dzaharudin, Fatimah Mat Nor, Mohd. Basri
author_sort	Md Ralib, Azrina
title	Estimates of glomerular filtration rate in the critically ill with sepsis
title_short	Estimates of glomerular filtration rate in the critically ill with sepsis
title_full	Estimates of glomerular filtration rate in the critically ill with sepsis
title_fullStr	Estimates of glomerular filtration rate in the critically ill with sepsis
title_full_unstemmed	Estimates of glomerular filtration rate in the critically ill with sepsis
title_sort	estimates of glomerular filtration rate in the critically ill with sepsis
publisher	Elsevier BV
publishDate	2017
url	http://irep.iium.edu.my/58074/ http://irep.iium.edu.my/58074/ http://irep.iium.edu.my/58074/1/1-s2.0-S2468024917302723-main.pdf http://irep.iium.edu.my/58074/11/58074_ESTIMATES%20OF%20GLOMERULAR_acceptance%20letter.pdf
first_indexed	2023-09-18T21:22:06Z
last_indexed	2023-09-18T21:22:06Z
_version_	1777411950123155456

Estimates of glomerular filtration rate in the critically ill with sepsis

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