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Hekmat, Reza; Eshraghi, Hamid; Esmailpour, Maryam; Hassankhani, Golnaz Ghayyem

doi:10.6002/ect.mesot2016.o104

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…KeGFR has been also tested in patients undergoing cardiac surgery for predicting AKI and operative mortality[14]. The equation has also been implemented in the renal transplant population to improve early AKI detection in living donors [32], to predict delayed graft function in renal transplant recipients [10,13] and as a secondary endpoint for a randomized clinical trial where those randomized to balanced salt solutions (Plasma-lyte) versus normal saline trended towards better keGFR [33]. Together, these studies show that keGFR improves prediction and understanding of renal function in AKI when the serum creatinine is rapidly fluctuating.…”

Section: Discussionmentioning

confidence: 99%

The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury

et al. 2019

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BackgroundIn acute kidney injury (AKI), medication dosing based on Cockcroft-Gault creatinine clearance (CrCl) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rates (eGFR) are not valid when serum creatinine (SCr) is not in steady state. The aim of this study was to determine the impact of a kinetic estimating equation that incorporates fluctuations in SCrs on drug dosing in critically ill patients.MethodsWe used data from participants enrolled in the NIH Acute Respiratory Distress Syndrome Network Fluid and Catheters Treatment Trial to simulate drug dosing category changes with the application of the kinetic estimating equation developed by Chen. We evaluated whether kinetic estimation of renal function would change medication dosing categories (≥60, 30–59, 15–29, and <15mL/min) compared with the use of CrCl or CKD-EPI eGFR.ResultsThe use of kinetic CrCl and CKD-EPI eGFR resulted in a large enough change in estimated renal function to require medication dosing recategorization in 19.3% [95 CI 16.8%–21.9%] and 23.4% [95% CI 20.7%–26.1%] of participants, respectively. As expected, recategorization occurred more frequently in those with AKI. When we examined individual days for those with AKI, dosing discordance was observed in 8.5% of total days using the CG CrCl and 10.2% of total days using the CKD-EPI equation compared with the kinetic counterparts.ConclusionIn a critically ill population, use of kinetic estimates of renal function impacted medication dosing in a substantial proportion of AKI participants. Use of kinetic estimates in clinical practice should lower the incidence of medication toxicity as well as avoid subtherapeutic dosing during renal recovery.

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Section: Discussionmentioning

confidence: 99%

The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury

et al. 2019

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“…Incident patients who were on maintenance hemodialysis for at least 3 months were included in the study cohort. Patients included in the study were diagnosed with ESRD if they suffer an irreversible decline in glomerular filtration rate for more than 3 months as calculated by Cockcroft-Gault renal function estimating formula [ 9 ]. Moreover, patients who had underlying kidney disease diagnosed on the basis of clinical and laboratory parameters, such as the volume of daily diuresis less than 250 mL, were also included in the study.…”

Section: Methodsmentioning

confidence: 99%

Association of Dose and Frequency on the Survival of Patients on Maintenance of Hemodialysis in China: A Kaplan-Meier and Cox-Proportional Hazard Model Analysis

Sun

Wang

et al. 2018

Med Sci Monit

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BackgroundDialysis frequency and dose are controversial prognostic factors of hemodialysis morbidity and mortality. The aim of this study was to find out the effect of frequency and dosage of dialysis on mortality and survival in a group of Chinese hemodialysis patients.Material/MethodsIn total, 183 patients seen from February 2008 to January 2018, who were on maintenance hemodialysis for at least 3 months, were included in the study cohort. An anonymized database of age, gender, diabetic status, comorbidities, date of initiation of dialysis, hematological characters, biochemical variables, and status of survived or died was established from DICOM (Digital Imaging and Communications in Medicine) files of patients. Kaplan-Meier and Cox-proportional hazard model was used for calculation of survival over time at 95% confidence level.ResultsOverall, the 10-year survival rate was 27%. Kaplan-Meier analysis showed patient survival as 94% at one-year, 59% at 5-years, and 27% at 10-years. Hemoglobin, serum albumin, calcium, potassium, phosphorous, calcium-phosphorous-products, and hemodialysis frequency and the dose had a significant effect on survival. Cox regression proportional hazard model showed that patients with serum albumin level of >4 g/dL were better associated with survival. Patients who underwent twice-weekly hemodialysis had 4.26 times less chance of survival as compared to patients with thrice-weekly hemodialysis. A higher dialysis dose of >1.2 spKt/V offered better survival as compared to a lower dose of <1.2 spKt/V.ConclusionsHypoalbuminemia, hemodialysis time, and hemodialysis frequency were significantly associated with mortality.

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“…The original algebraic equation has been tested extensively in clinical research and has performed admirably. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 In 2018, the GFR K equation was upgraded with calculus to accommodate a volume that changes steadily. 3 To remodel the algebraic into a calculus version, we had to figure out the exact substitute for the mean.…”

Section: Mean [Cr] Reduxmentioning

confidence: 99%

Estimating Creatinine Clearance in the Nonsteady State: The Determination and Role of the True Average Creatinine Concentration

Chen

Chiaramonte

2019

Kidney Medicine

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Creatinine clearance is a tenet of nephrology practice. However, with just a single creatinine concentration included in the denominator of the creatinine clearance equation, the resulting value seems to apply only in the steady state. Does the basic clearance formula work in the nonsteady state, and can it recapitulate the kinetic glomerular filtration rate (GFR) equation? In the kinetic state, a nonlinear creatinine trajectory is reducible into a "true average" value that can be found using calculus, proceeding from a differential equation based on the mass balance principle. Using the fundamental theorem of calculus, we prove definitively that the true average is the correct creatinine to divide by, even as the mathematical model accommodates clinical complexities such as volume change and other factors that affect creatinine kinetics. The true average of a creatinine versus time function between 2 measured creatinine values is found by a definite integral. To use the true average to compute kinetic GFR, 2 techniques are demonstrated, a graphical one and a numerical one. We apply this concept to a clinical case of an individual with acute kidney injury requiring dialysis; despite the effects of hemodialysis on serum creatinine concentration, kinetic GFR was able to track the underlying kidney function and provided critical information regarding kidney function recovery. Finally, a prior concept of the maximum increase in creatinine per day is made more clinically objective. Thus, the clearance paradigm applies to the nonsteady state as well when the true average creatinine is used, providing a fundamentally valid strategy to deduce kinetic GFRs from serum creatinine trends occurring in real-life acute kidney injury and kidney recovery.

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Untitled

Cited by 4 publications

References 13 publications

The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury

The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury

Association of Dose and Frequency on the Survival of Patients on Maintenance of Hemodialysis in China: A Kaplan-Meier and Cox-Proportional Hazard Model Analysis

Estimating Creatinine Clearance in the Nonsteady State: The Determination and Role of the True Average Creatinine Concentration

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