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Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study

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Abstract

Objective

To estimate the usefulness of 2-h creatinine clearance (CrCl) in the ICU and define variables that may reduce agreement.

Design

Prospective study.

Setting

Polyvalent ICU of a university hospital.

Patients

359 patients.

Interventions

We compared 24-h CrCl (CrCl-24h), as the standard measure, with 2-h CrCl (CrCl-2h) (at the start of the period) and the Cockroft–Gault equation (Ck-G).

Measurements and results

The 2-h sample was lost in two patients (0.6%) and the 24-h sample was lost in 50 patients (13.9%). The mean Ck-G was 87.4 ± 3.05, with CrCl-2h 109.2 ± 4.46 and CrCl-24h 100.9 ± 4.21 ml/min/1.73 m2 (r 2 of 0.88 for CrCl-2h and 0.84 for Ck-G). The differences from ClCr-24h were 21.8 ± 3.3 ( p < 0.001) for the Ck-G and 8.3 ± 2.6 ( p < 0.05) for CrCl-2h ( p < 0.05). In the subgroup of patients with CrCl-24h < 100 ml/min/1.73 m2, the CrCl-24h value was 52.9 ± 2.71 vs. 51.6 ± 2.14 for CrCl-2h ( p = ns) and 57.6 ± 2.56 ( p < 0.001) for the Ck-G. Patients with CrCl < 100 ml/min only showed variability in hyperglycemia during the 24-h period.

Conclusions

In intensive care patients, 24-h CrCl results in a large proportion of non-valid determinations, even under conditions of close monitoring. Two-hour CrCl is an adequate substitute, even in patients who are unstable or who have irregular diuresis where a 24-h collection is impossible. The Cockroft–Gault equation seems less useful in this setting.

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References

  1. Liaño F, Junco E, Pascual J, Madero R, Verde E, Madrid Acute Renal Failure Study Group (1988) The spectrum of acute renal failure in intensive care unit compared with that seen in other settings. Kidney International 53:S16–S24

    Google Scholar 

  2. Herrera-Gutiérrez ME, Seller-Pérez G, Maynar-Moliner J, Sanchez-Izquierdo-Riera JA, grupo FRAMI de la SEMICYUC (2006) Epidemiología del FRA en las UCI españolas: estudio prospectivo multicéntrico FRAMI. Med Intensiva 30:260–267

    PubMed  Google Scholar 

  3. Bellomo R, Ronco C, Kellum JA, Metha RL, Palevsky P, ADQI workgroup (2004) Acute renal failure: definition, outcome, measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:204–212

    Article  Google Scholar 

  4. Bellomo R, Kellum JA, Ronco C (2004) Defining acute renal failure: physiological principles. Intensive Care Med 30:33–37

    Article  PubMed  Google Scholar 

  5. Seller-Pérez G, Herrera-Gutiérrez ME, Banderas-Bravo E, Muñoz-Bono J, Fernández-Ortega J, Lebrón-Gallardo M (2005) Validation of 2 hours sampling creatinine clearance in ICU population, included unstable patients. Intensive Care Med (Suppl) 31(1):S146

    Google Scholar 

  6. Levey AS, Bosh JP, Lewis JB, Green T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470

    PubMed  CAS  Google Scholar 

  7. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710

    PubMed  CAS  Google Scholar 

  8. Menitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Drum WL (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058

    Article  Google Scholar 

  9. Ahlström A, Tallgren M, Peltonen S, Räsänen P, Pettilä V (2005) Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med 31:1222–1228

    Article  PubMed  Google Scholar 

  10. Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, de Backer D, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R (2006) Year in review in intensive care medicine. 2005. I. Acute respiratory failure and acute lung injury, ventilation, hemodynamics, education, renal failure. Intensive Care Med DOI 10.1007/s00134-005-0027-z

  11. Hewitt SM, Dear J, Star RA (2004) Discovery of protein biomarkers for renal disease. J Am Soc Nephrol 15:1677–1689

    Article  PubMed  Google Scholar 

  12. Han WK, Bonventre JV (2004) Biologic markers for the early detection of acute kidney injury. Curr Opin Crit Care 10:476–482

    Article  PubMed  Google Scholar 

  13. Schrier RW, Wang W, Poole B, Mitra A (2004) Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest 114:5–14

    Article  PubMed  CAS  Google Scholar 

  14. Moran SM, Meyers BD (1985) Course of acute renal failure studied by a model of creatinine kinetics. Kidney Int 27:928–937

    Article  PubMed  CAS  Google Scholar 

  15. Lameire N, Hoste E (2004) Reflections on the definition, classification, and diagnostic evaluation of acute renal failure. Curr Opin Crit Care 10:468–475

    Article  PubMed  Google Scholar 

  16. Han WK, Bailly V, Abichandani R, Thadhani R. Bonventre JV (2002) Kidney injury molecule-1 (KIM-1): a novel biomarker for human renal proximal tubule injury. Kidney Int 62:237–244

    Article  PubMed  CAS  Google Scholar 

  17. Hoste EA, Damen J, Vanholder RC, Lameire NH, Delanghe JR, Van den Hauwe KV, Colardyn FA (2005) Assessment of renal function in recently admitted critically ill patients with normal serum creatinine. Nephrol Dial Transplant 20:747–753

    Article  PubMed  CAS  Google Scholar 

  18. Liu KD (2003) Molecular mechanisms of recovery from acute renal failure. Crit Care Med 31:S572–S581

    Article  PubMed  CAS  Google Scholar 

  19. Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling CR (2005) Optimal follow-up time alter continuous replacement therapy in actual renal failure patients stratified with the RIFLE criteria. Nephrol Dial Transplant 20:354–360

    Article  PubMed  Google Scholar 

  20. Jelliffe R (2002) Estimation of creatinine clearance in patients with unstable renal function, without a urine specimen. Am J Nephrol 22:320–324

    Article  PubMed  Google Scholar 

  21. Cockroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  Google Scholar 

  22. Kim KE, Onesti G, Ramirez O (1969) Creatinine clearance in renal disease: a reappraisal. BMJ 4:11–19

    Article  PubMed  CAS  Google Scholar 

  23. O'Connell MB, Wong MO, Bannick SD, Dwinell AM (1993) Accuracy of 2 and 8 hour urine collections for measuring creatinine clearance in the hospitalized elderly. Pharmacotherapy 13:135–142

    PubMed  Google Scholar 

  24. Baumann TJ, Staddon JS, Horst HM, Bivins BA (1987) Minimum urine collections periods for accurate determinations of creatinine clearance in critically ill patients. Clin Pharm 6:393–398

    PubMed  CAS  Google Scholar 

  25. Wilson RF, Soullier G (1980) The validity of two hour creatinine clearance studies in critically ill patients. Crit Care Med 8:281–284

    Article  PubMed  CAS  Google Scholar 

  26. Herget-Rosenthal S, Kribben A, Pietruck F, Ross B, Philipp T (1999) Two by two hour creatinine clearance: repeatable and valid. Clin Nephrol 51:348–354

    PubMed  CAS  Google Scholar 

  27. Uchino S, Doig G, Bellomo R, Motimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Nacedo E, Gibney N, Tolwani A, Ronco C, Kellum JA, the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) investigators (2004) Diuretics and mortality in acute renal failure. Crit Care Med 32:1669–1677

    Article  PubMed  Google Scholar 

  28. Stevens LA, Coresh J, Greene T, Levey AS (2006) Assessing kidney function – measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483

    Article  PubMed  CAS  Google Scholar 

  29. Delanaye P, Lambermont B, Chapelle JP, Gielen J, Gerard P, Rorive G (2004) Plasmatic cystatin C for the estimation of glomerular filtration rate in intensive care units. Intensive Care Med 30:980–983

    Article  PubMed  Google Scholar 

  30. Villa P, Jiménez M, Soriano MC, Manzanares J, Casasnovas P (2005) Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients. Critical Care 9:139–143

    Article  Google Scholar 

  31. Herget-Rosenthal S, Marggaf G, Husing J, Goring F, Pietruck F, Janssen O, Philipp T, Kribben A (2004) Early detection of acute renal failure by serum cystatin C. Kidney Int 66:1115–1122

    Article  PubMed  CAS  Google Scholar 

  32. Filler G, Foster J, Acker A, Lepage N, Akbari A, Ehrich JHH (2005) The Cockroft–Gault equation should not be used in children. Kidney Int 75:2321–2324

    Article  Google Scholar 

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Authors and Affiliations

  1. Intensive Care Medicine, Carlos Haya University Hospital, 29018, Malaga, Spain

    Manuel E. Herrera-Gutiérrez, Gemma Seller-Pérez, Esther Banderas-Bravo, Javier Muñoz-Bono, Miguel Lebrón-Gallardo & Juan F. Fernandez-Ortega

Authors
  1. Manuel E. Herrera-Gutiérrez
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  2. Gemma Seller-Pérez
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  3. Esther Banderas-Bravo
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  4. Javier Muñoz-Bono
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  5. Miguel Lebrón-Gallardo
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  6. Juan F. Fernandez-Ortega
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Corresponding author

Correspondence to Manuel E. Herrera-Gutiérrez.

Additional information

All the authors participated actively in the present study. This is an original paper that has not been submitted for publication elsewhere, though partial results of the study were presented at the Annual Congress of the ESICM in Amsterdam (September 2005), and the final results were presented at the Annual Congress of the SEMICYUC (Pamplona, 2006).

The authors received no external financing for conduct of the study, and there are no conflicts of interest for any of them.

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-007-0766-0.

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Herrera-Gutiérrez, M.E., Seller-Pérez, G., Banderas-Bravo, E. et al. Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study. Intensive Care Med 33, 1900–1906 (2007). https://doi.org/10.1007/s00134-007-0745-5

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  • DOI: https://doi.org/10.1007/s00134-007-0745-5

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