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Comparison of different equations to assess glomerular filtration in critically ill patients

(2015) INTENSIVE CARE MEDICINE. 41(3). p.427-435
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Abstract
Purpose: The purpose of this study was to evaluate equations for estimation of glomerular filtration rate (GFR) and measured urinary creatinine clearance, compared to measured GFR in critically ill patients. Methods: GFR was measured using inulin clearance. Multiple blood samples were collected per patient for determination of serum creatinine, cystatin C and inulin. GFR was estimated by the use of estimation equations (eGFR), which were: 4 commonly used creatinine based estimation equations [Cockcroft-Gault, Modification of Diet in Renal Disease (both the short and long formula) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)], 5 cystatin C based estimation equations (Hoek, Larsson, Filler, Le Bricon, CKD-EPIcys) and 1 equation combining cystatin C and serum creatinine (CKD-EPIcr-cys). In addition we measured urinary creatinine clearance. Bias, precision and accuracy of all estimates were compared to the inulin clearance. Results: Data were collected from 83 patients, of whom 68 were considered evaluable. The median age was 58 years ([interquartile range (IQR) 39-68)]. The median inulin clearance was 80 mL/min/1.73 m² (IQR 31-114). Equations based on creatinine had much bias and poor precision and accuracy. Measured urinary creatinine clearances overestimated GFR. Equations based on cystatin C were free of bias, but also had limited precision and accuracy. Conclusions: In this cohort of patients, estimates of GFR had low accuracy and precision. Cystatin C based formulas, especially CKD-EPIcr-cys, showed limited bias, however accuracy and precision were still insufficient. Measured urinary creatinine clearance overestimates GFR, but may provide a cheap alternative, when this is taken into account.
Keywords
VALUES, GFR, ICU PATIENTS, PLASMA CREATININE, INTENSIVE-CARE, CREATININE CLEARANCE, AUGMENTED RENAL CLEARANCE, SERUM CYSTATIN-C, Cystatin C, ACUTE KIDNEY INJURY, augmented renal clearance, kidney function, Hyperfiltration, ARC, ICU, intensive care unit, critical care medicine, inulin clearance, glomerular filtration rate, creatinine clearance, FORMULA

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Citation

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Chicago
Carlier, Mieke, Alexander Dumoulin, Alexander Janssen, Sven Picavet, Steve Vanthuyne, Ria Van Eynde, Raymond Vanholder, et al. 2015. “Comparison of Different Equations to Assess Glomerular Filtration in Critically Ill Patients.” Intensive Care Medicine 41 (3): 427–435.
APA
Carlier, Mieke, Dumoulin, A., Janssen, A., Picavet, S., Vanthuyne, S., Van Eynde, R., Vanholder, R., et al. (2015). Comparison of different equations to assess glomerular filtration in critically ill patients. INTENSIVE CARE MEDICINE, 41(3), 427–435.
Vancouver
1.
Carlier M, Dumoulin A, Janssen A, Picavet S, Vanthuyne S, Van Eynde R, et al. Comparison of different equations to assess glomerular filtration in critically ill patients. INTENSIVE CARE MEDICINE. 2015;41(3):427–35.
MLA
Carlier, Mieke, Alexander Dumoulin, Alexander Janssen, et al. “Comparison of Different Equations to Assess Glomerular Filtration in Critically Ill Patients.” INTENSIVE CARE MEDICINE 41.3 (2015): 427–435. Print.
@article{5791447,
  abstract     = {Purpose: The purpose of this study was to evaluate equations for estimation of glomerular filtration rate (GFR) and measured urinary creatinine clearance, compared to measured GFR in critically ill patients.  
Methods: GFR was measured using inulin clearance. Multiple blood samples were collected per patient for determination of serum creatinine, cystatin C and inulin. GFR was estimated by the use of estimation equations (eGFR), which were: 4 commonly used creatinine based estimation equations [Cockcroft-Gault, Modification of Diet in Renal Disease (both the short and long formula) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)], 5 cystatin C based estimation equations (Hoek, Larsson, Filler, Le Bricon, CKD-EPIcys) and 1 equation combining cystatin C and serum creatinine (CKD-EPIcr-cys). In addition we measured urinary creatinine clearance. Bias, precision and accuracy of all estimates were compared to the inulin clearance.   
Results: Data were collected from 83 patients, of whom 68 were considered evaluable. The median age was 58 years ([interquartile range (IQR) 39-68)]. The median inulin clearance was 80 mL/min/1.73 m{\texttwosuperior} (IQR 31-114). Equations based on creatinine had much bias and poor precision and accuracy. Measured urinary creatinine clearances overestimated GFR. Equations based on cystatin C were free of bias, but also had limited precision and accuracy. 
Conclusions: In this cohort of patients, estimates of GFR had low accuracy and precision. Cystatin C based formulas, especially CKD-EPIcr-cys, showed limited bias, however accuracy and precision were still insufficient. Measured urinary creatinine clearance overestimates GFR, but may provide a cheap alternative, when this is taken into account.},
  author       = {Carlier, Mieke and Dumoulin, Alexander and Janssen, Alexander and Picavet, Sven and Vanthuyne, Steve and Van Eynde, Ria and Vanholder, Raymond and Delanghe, Joris and De Schoenmakere, Gert and De Waele, Jan and Hoste, Eric},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  keyword      = {VALUES,GFR,ICU PATIENTS,PLASMA CREATININE,INTENSIVE-CARE,CREATININE CLEARANCE,AUGMENTED RENAL CLEARANCE,SERUM CYSTATIN-C,Cystatin C,ACUTE KIDNEY INJURY,augmented renal clearance,kidney function,Hyperfiltration,ARC,ICU,intensive care unit,critical care medicine,inulin clearance,glomerular filtration rate,creatinine clearance,FORMULA},
  language     = {eng},
  number       = {3},
  pages        = {427--435},
  title        = {Comparison of different equations to assess glomerular filtration in critically ill patients},
  url          = {http://dx.doi.org/10.1007/s00134-014-3641-9},
  volume       = {41},
  year         = {2015},
}

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