Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury - true GFR versus urinary creatinine clearance and estimating equations

Bragadottir, Gudrun; Redfors, Bengt; Ricksten, Sven‐Erik

doi:10.1186/cc12777

Cited by 145 publications

(127 citation statements)

References 33 publications

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“…In critically ill patients, assessing the glomerular filtration rate by means of serum creatinine levels can be questioned. Urinary CL CR , though more specific, bears the same limitations (38). We used the MDRD formula for basal estimation of the glomerular filtration rate, following the recommendation for RIFLE classification.…”

Section: Discussionmentioning

confidence: 99%

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Picard

Bazin

Clouzeau

et al. 2014

Antimicrob Agents Chemother

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cTo assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ؎ 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk ‫؍‬ 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.A minoglycosides (AGs) have bactericidal activity, which has been proven to be synergic with that of ␤-lactams. Although adding an AG to a standard antibiotic treatment did not translate into a reduction of mortality in Gram-negative-bacterial sepsis in subgroups of patients with globally moderate degrees of severity (1), a decrease in mortality was recently reported in a meta-analysis comparing a bitherapy to therapy with a ␤-lactam alone for patients with septic shock (2). In addition, AGs widen the spectrum of the antibiotic treatment, which should be advantageous in populations with an increased risk of resistant bacteria, such as intensive care unit (ICU) patients (3, 4). Empirical antibiotic treatments including AGs could be more appropriate in up to 15 to 20% of cases than a ␤-lactam alone (5, 6). In the ICU setting, modifications of the empirical antibiotic treatment or the addition of a new antibiotic occurs less frequently after bitherapy including an AG than after monotherapy (7).Unfortunately, nephrotoxicity is an important potential limitation of AGs. There is a consensus that AG-related nephrotoxicity has decreased over the years due to better consideration of both reduced duration of treatment and once-daily administration (8). However...

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Section: Discussionmentioning

confidence: 99%

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Picard

Bazin

Clouzeau

et al. 2014

Antimicrob Agents Chemother

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“…Biomarkers in predicting CI-AKI According to some authors, 39 serum creatinine is not an adequate marker of renal function. The reasons for this concern are as follows: 1) Variation in its production from muscles and hence it may vary with age, sex, race, and weight, which affect muscle mass.…”

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confidence: 99%

The potential use of biomarkers in predicting contrast-induced acute kidney injury

Andreucci¹,

Faga²,

Riccio³

et al. 2016

IJNRD

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Contrast-induced acute kidney injury (CI-AKI) is a problem associated with the use of iodinated contrast media, causing kidney dysfunction in patients with preexisting renal failure. It accounts for 12% of all hospital-acquired kidney failure and increases the length of hospitalization, a situation that is worsening with increasing numbers of patients with comorbidities, including those requiring cardiovascular interventional procedures. So far, its diagnosis has relied upon the rise in creatinine levels, which is a late marker of kidney damage and is believed to be inadequate. Therefore, there is an urgent need for biomarkers that can detect CI-AKI sooner and more reliably. In recent years, many new biomarkers have been characterized for AKI, and these are discussed particularly with their use in known CI-AKI models and studies and include neutrophil gelatinase-associated lipocalin, cystatin C (Cys-C), kidney injury molecule-1, interleukin-18, N-acetyl-β-d-glucosaminidase, and L-type fatty acid-binding protein (L-FABP). The potential of miRNA and metabolomic technology is also mentioned. Early detection of CI-AKI may lead to early intervention and therefore improve patient outcome, and in future any one or a combination of several of these markers together with development in technology for their analysis may prove effective in this respect.

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“…In septic AKI patients, renal function was reported not to decline as low as expected, which could lead to underestimation of glomerular filtration rate and insufficient drug dosing [10]. This phenomenon is termed aug- mented renal clearance in which renal function for solution clearance is elevated more than expected by visible laboratory data in critically ill patients [11,12].…”

Section: Discussionmentioning

confidence: 99%

Increased Creatinine Clearance in Acute Kidney Injury due to Heat Stroke

Urabe¹,

Kotani²,

Tsujimoto³

2018

J Med Cases

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Acute kidney injury (AKI) is associated with increased mortality and risk of chronic kidney disease (CKD). Whereas AKI is well known to occur frequently in patients with heat stroke, creatinine clearance levels of these patients have not been evaluated in literature. In this report, we present the case of a patient with increased creatinine clearance who developed AKI due to heat stroke. A 40-year-old male with no past medical history was admitted to the intensive care unit of our hospital due to AKI from heat stroke. Although he was diagnosed with stage 3 AKI at admission, his creatinine clearance, measured by a 12-h urine collection, was highly elevated to 230 mL/min/1.73 m 2 . His serum creatinine was decreased to the baseline level 12 h after admission, with fluid resuscitation. This case can suggest that creatinine clearance might be underestimated, although serum creatinine levels are elevated in AKI due to heat stroke.

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Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury - true GFR versus urinary creatinine clearance and estimating equations

Cited by 145 publications

References 33 publications

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

The potential use of biomarkers in predicting contrast-induced acute kidney injury

Increased Creatinine Clearance in Acute Kidney Injury due to Heat Stroke

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