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

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Abstract

Purpose

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 the following estimation equations (eGFR): four commonly used creatinine-based equations [Cockcroft–Gault, Modification of Diet in Renal Disease (both the short and long formula) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)], five cystatin C based estimation equations (Hoek, Larsson, Filler, Le Bricon, CKD-EPIcys) and one 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 those of 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, the accuracy and precision of these estimates were still insufficient. Measured urinary creatinine clearance overestimates GFR, but may provide a cheap alternative, when this is taken into account.

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Acknowledgments

M. Carlier is funded through a pre-doctoral mandate by the Research Foundation Flanders. E. Hoste and J. De Waele are both senior clinical investigators from the Research Foundation Flanders. We would like to thank Mrs. Waterloos from the Department of Nephrology for measurement of inulin concentrations.

Conflicts of interest

EH has received speakers fees from Astute Medical and contributed to clinical studies on biomarkers from the same company. In addition, he is co-investigator for an academic sponsored study on kidney biomarkers. The other authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium

    Mieke Carlier & Joris Delanghe

  2. De Pintelaan 185 Building 2P8, 9000, Ghent, Belgium

    Mieke Carlier

  3. Department of Critical Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium

    Mieke Carlier, Jan J. De Waele & Eric A. J. Hoste

  4. Research Foundation Flanders, Brussels, Belgium

    Mieke Carlier, Jan J. De Waele & Eric A. J. Hoste

  5. Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium

    Alexander Dumoulin

  6. Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium

    Alexander Janssen

  7. Department of Anesthesiology and Intensive Care Medicine, AZ Jan Palfijn, Ghent, Belgium

    Sven Picavet

  8. Department of Anesthesiology and Intensive Care Medicine, ZorgSaam Hospital, Terneuzen, The Netherlands

    Steve Vanthuyne

  9. Department of Anesthesiology, AZ Sint Lucas, Ghent, Belgium

    Ria Van Eynde

  10. Department of Nephrology, Ghent University Hospital, Ghent, Belgium

    Raymond Vanholder

  11. Department of Nephrology, Heilig Hart Ziekenhuis, Roeselare, Belgium

    Gert De Schoenmakere

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  1. Mieke Carlier
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  2. Alexander Dumoulin
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  10. Jan J. De Waele
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  11. Eric A. J. Hoste
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Corresponding author

Correspondence to Mieke Carlier.

Additional information

Take home message: Estimates of glomerular filtration rate (GFR) (including measured urinary creatinine clearance) have low accuracy and precision in critically ill patients. Equations based on creatinine performed worst and should not be used in critically ill patients. Cystatin C based formulas, especially the newest CKD-EPIcr-cys, performed reasonably. When overestimation of GFR is taken into account, urinary creatinine clearance measurement may provide a cheaper alternative with comparable accuracy and precision.

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Carlier, M., Dumoulin, A., Janssen, A. et al. Comparison of different equations to assess glomerular filtration in critically ill patients. Intensive Care Med 41, 427–435 (2015). https://doi.org/10.1007/s00134-014-3641-9

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  • DOI: https://doi.org/10.1007/s00134-014-3641-9

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