The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill Patients
The performance of glomerular filtration rate- (GFR-) estimating equations was studied against creatinine clearance measured by 24-hour urine collection (CrCl24h-urine) in critically ill patients. Methods. In this substudy of the PermiT trial (https://clinicaltrials.gov/ct2/show/ISRCTN68144998), pat...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-01-01
|
| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2021/5520653 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832547023797092352 |
|---|---|
| author | Hasan M. Al-Dorzi Abdulmajeed A. Alsadhan Ayman S. Almozaini Ali M Alamri Hani Tamim Musharraf Sadat Lolowa Al-Swaidan Elwaleed Elhassan Yaseen M. Arabi |
| author_facet | Hasan M. Al-Dorzi Abdulmajeed A. Alsadhan Ayman S. Almozaini Ali M Alamri Hani Tamim Musharraf Sadat Lolowa Al-Swaidan Elwaleed Elhassan Yaseen M. Arabi |
| author_sort | Hasan M. Al-Dorzi |
| collection | DOAJ |
| description | The performance of glomerular filtration rate- (GFR-) estimating equations was studied against creatinine clearance measured by 24-hour urine collection (CrCl24h-urine) in critically ill patients. Methods. In this substudy of the PermiT trial (https://clinicaltrials.gov/ct2/show/ISRCTN68144998), patients from King Abdulaziz Medical City-Riyadh who had CrCl24h-urine were included. We estimated GFR using Cockroft–Gault (CG), modification of diet in renal disease study (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), and Jelliffe equations. For the CG equation, we entered the actual weight in one calculation (CGactual-wt), and if BMI ≥30 kg/m2, we entered the ideal body weight (CGideal-wt) and the adjusted body weight (CGadjusted-wt) in two calculations. We calculated the MDRD equation based on 4 (MDRD-4) and 6 variables (MDRD-6). The performance of these equations was assessed by different ways including Spearman correlation, bias (difference between estimated GFR and CrCl24h-urine), precision (standard deviation of bias), and Bland–Altman plot analysis. Results. The cohort consisted of 237 patients (age 45 ± 20 years, males 75%, mechanically ventilated 99% with serum creatinine 101 ± 94 µmol/L and CrCl24h-urine 108 ± 69 ml/min/1.73 m2). The correlations between the different equations and CrCl24h-urine were modest (r: 0.62 to 0.79; p<0.0001). Bias was statistically significant for CGactual-wt (21 ml/min), CGadjusted-wt (12 ml/min), and MDRD-6 (-10 ml/min) equations. Precision ranged from 46 to 54 ml/min. The sensitivity of equations to correctly classify CrCl24h-urine 30–59.9 ml/min/1.73 m2 was 17.2% for CGactual-wt, 30.0% for CGideal-wt, 31.0% for CGadjusted-wt, 31.0% for MDRD-4, 39.1% for MDRD-6, 13.8% for CKD-EPI, and 34.5% for Jelliffe equation. Conclusions. Commonly used GFR-estimating equations had limited ability to properly estimate CrCl24h-urine and to correctly classify GFR into clinically relevant ranges that usually determine dosing of medications. |
| format | Article |
| id | doaj-art-8ee8015be4db4467a879da4b5f600755 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-8ee8015be4db4467a879da4b5f6007552025-02-03T06:46:14ZengWileyCritical Care Research and Practice2090-13052090-13132021-01-01202110.1155/2021/55206535520653The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill PatientsHasan M. Al-Dorzi0Abdulmajeed A. Alsadhan1Ayman S. Almozaini2Ali M Alamri3Hani Tamim4Musharraf Sadat5Lolowa Al-Swaidan6Elwaleed Elhassan7Yaseen M. Arabi8College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Internal Medicine Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Internal Medicine Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Internal Medicine Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaThe performance of glomerular filtration rate- (GFR-) estimating equations was studied against creatinine clearance measured by 24-hour urine collection (CrCl24h-urine) in critically ill patients. Methods. In this substudy of the PermiT trial (https://clinicaltrials.gov/ct2/show/ISRCTN68144998), patients from King Abdulaziz Medical City-Riyadh who had CrCl24h-urine were included. We estimated GFR using Cockroft–Gault (CG), modification of diet in renal disease study (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), and Jelliffe equations. For the CG equation, we entered the actual weight in one calculation (CGactual-wt), and if BMI ≥30 kg/m2, we entered the ideal body weight (CGideal-wt) and the adjusted body weight (CGadjusted-wt) in two calculations. We calculated the MDRD equation based on 4 (MDRD-4) and 6 variables (MDRD-6). The performance of these equations was assessed by different ways including Spearman correlation, bias (difference between estimated GFR and CrCl24h-urine), precision (standard deviation of bias), and Bland–Altman plot analysis. Results. The cohort consisted of 237 patients (age 45 ± 20 years, males 75%, mechanically ventilated 99% with serum creatinine 101 ± 94 µmol/L and CrCl24h-urine 108 ± 69 ml/min/1.73 m2). The correlations between the different equations and CrCl24h-urine were modest (r: 0.62 to 0.79; p<0.0001). Bias was statistically significant for CGactual-wt (21 ml/min), CGadjusted-wt (12 ml/min), and MDRD-6 (-10 ml/min) equations. Precision ranged from 46 to 54 ml/min. The sensitivity of equations to correctly classify CrCl24h-urine 30–59.9 ml/min/1.73 m2 was 17.2% for CGactual-wt, 30.0% for CGideal-wt, 31.0% for CGadjusted-wt, 31.0% for MDRD-4, 39.1% for MDRD-6, 13.8% for CKD-EPI, and 34.5% for Jelliffe equation. Conclusions. Commonly used GFR-estimating equations had limited ability to properly estimate CrCl24h-urine and to correctly classify GFR into clinically relevant ranges that usually determine dosing of medications.http://dx.doi.org/10.1155/2021/5520653 |
| spellingShingle | Hasan M. Al-Dorzi Abdulmajeed A. Alsadhan Ayman S. Almozaini Ali M Alamri Hani Tamim Musharraf Sadat Lolowa Al-Swaidan Elwaleed Elhassan Yaseen M. Arabi The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill Patients Critical Care Research and Practice |
| title | The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill Patients |
| title_full | The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill Patients |
| title_fullStr | The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill Patients |
| title_full_unstemmed | The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill Patients |
| title_short | The Performance of Equations That Estimate Glomerular Filtration Rate against Measured Urinary Creatinine Clearance in Critically Ill Patients |
| title_sort | performance of equations that estimate glomerular filtration rate against measured urinary creatinine clearance in critically ill patients |
| url | http://dx.doi.org/10.1155/2021/5520653 |
| work_keys_str_mv | AT hasanmaldorzi theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT abdulmajeedaalsadhan theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT aymansalmozaini theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT alimalamri theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT hanitamim theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT musharrafsadat theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT lolowaalswaidan theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT elwaleedelhassan theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT yaseenmarabi theperformanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT hasanmaldorzi performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT abdulmajeedaalsadhan performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT aymansalmozaini performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT alimalamri performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT hanitamim performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT musharrafsadat performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT lolowaalswaidan performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT elwaleedelhassan performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients AT yaseenmarabi performanceofequationsthatestimateglomerularfiltrationrateagainstmeasuredurinarycreatinineclearanceincriticallyillpatients |