Top

Published in:

Open Access 01-12-2015 | Research

Screening of patients with augmented renal clearance in ICU: taking into account the CKD-EPI equation, the age, and the cause of admission

Authors: Stéphanie Ruiz, Vincent Minville, Karim Asehnoune, Marie Virtos, Bernard Georges, Olivier Fourcade, Jean-Marie Conil

Published in: Annals of Intensive Care | Issue 1/2015

Abstract

Background

In ICU patients with normal serum creatinine (SCr), a state of increased renal drug excretion has been described (creatinine clearance ≥130 ml/min/1.73 m²), and named augmented renal clearance (ARC). In ICU patients, the accuracy of GFR estimates is insufficient. However, in clinical practice, the physician has not at one’s disposal patient measured creatinine clearance (CrCl) when prescribing. The primary objective of this study was to assess the accuracy of 4 formulas to estimate GFR (Cockcroft-Gault (CG), Robert, sMDRD, and CKD-EPI formulas) with other covariates to detect ARC in ICU patients.

Methods

We enroled 360 consecutive ICU patients with normal SCr in this prospective observational study conducted in a primary teaching hospital. Comparisons between CrCl values and 4 estimated GFR (eGFR) formulas were estimated.

Results

In these 360 patients, ARC was observed in 33 % of patients most of them trauma. Individual predictive values of equations were poor and the phenomenon increased in ARC subgroup. CG and CKD-EPI were more accurate to detect an ARC. Multivariable analysis showed that the best-fitting model included 3 factors independently correlated to ARC: trauma patients, cut-off values of age ≤58 years, and CKD-EPI more than 108 ml/min/1.73 m².

Conclusions

In ICU patients with normal SCr, eGFR formulas are imprecise in assessing CrCl. If measured CrCl must be ideally used to detect modifications of the renal function, in clinical practice, age, reason for admission, and CKD-EPI could be used as screening tool to identify ARC.

Lautrette A, Phan TN, Ouchchane L, Aithssain A, Tixier V, Heng AE, et al. High creatinine clearance in critically ill patients with community-acquired acute infectious meningitis. BMC Nephrol. 2012;13:124. doi:10.1186/1471-2369-13-124.PubMedCentralCrossRefPubMed

Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.CrossRefPubMed

Robert S, Zarowitz BJ, Peterson EL, Dumler F. Predictability of creatinine clearance estimates in critically ill patients. Crit Care Med. 1993;21(10):1487–95.CrossRefPubMed

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. 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. 1999;130(6):461–70.CrossRefPubMed

Levey AS, Greene T, Kusek JW, Beck GJ. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol JASN. 2000;11:A155.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.PubMedCentralCrossRefPubMed

Minville V, Asehnoune K, Ruiz S, Breden A, Georges B, Seguin T, et al. Increased creatinine clearance in polytrauma patients with normal serum creatinine: a retrospective observational study. Crit Care. 2011;15(1):R49. doi:10.1186/cc10013.PubMedCentralCrossRefPubMed

Udy A, Boots R, Senthuran S, Stuart J, Deans R, Lassig-Smith M, et al. Augmented creatinine clearance in traumatic brain injury. Anesth Analg. 2010;111(6):1505–10. doi:10.1213/ANE.0b013e3181f7107d.CrossRefPubMed

Udy AA, Baptista JP, Lim NL, Joynt GM, Jarrett P, Wockner L, et al. Augmented renal clearance in the ICU: results of a multicenter observational study of renal function in critically ill patients with normal plasma creatinine concentrations*. Crit Care Med. 2014;42(3):520–7. doi:10.1097/CCM.0000000000000029.CrossRefPubMed

10.

Baptista JP, Sousa E, Martins PJ, Pimentel JM. Augmented renal clearance in septic patients and implications for vancomycin optimisation. Int J Antimicrob Agents. 2012;39(5):420–3. doi:10.1016/j.ijantimicag.2011.12.011.CrossRefPubMed

11.

Fuster-Lluch O, Geronimo-Pardo M, Peyro-Garcia R, Lizan-Garcia M. Glomerular hyperfiltration and albuminuria in critically ill patients. Anaesth Intensive Care. 2008;36(5):674–80.PubMed

12.

Udy AA, Putt MT, Shanmugathasan S, Roberts JA, Lipman J. Augmented renal clearance in the Intensive Care Unit: an illustrative case series. Int J Antimicrob Agents. 2010;35(6):606–8. doi:10.1016/j.ijantimicag.2010.02.013.CrossRefPubMed

13.

Udy AA, Roberts JA, Boots RJ, Paterson DL, Lipman J. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49(1):1–16. doi:10.2165/11318140-000000000-00000.CrossRefPubMed

14.

Udy AA, Varghese JM, Altukroni M, Briscoe S, McWhinney BC, Ungerer JP, et al. Subtherapeutic initial beta-lactam concentrations in select critically ill patients: association between augmented renal clearance and low trough drug concentrations. Chest. 2012;142(1):30–9. doi:10.1378/chest.11-1671.CrossRefPubMed

15.

Hoste EA, Damen J, Vanholder RC, Lameire NH, Delanghe JR, Van den Hauwe K, et al. Assessment of renal function in recently admitted critically ill patients with normal serum creatinine. Nephrol Dial Transpl Off Publ European Dial Transpl Assoc European Renal Assoc. 2005;20(4):747–53. doi:10.1093/ndt/gfh707.

16.

Baptista JP, Udy AA, Sousa E, Pimentel J, Wang L, Roberts JA, et al. A comparison of estimates of glomerular filtration in critically ill patients with augmented renal clearance. Crit Care. 2011;15(3):R139. doi:10.1186/cc10262.PubMedCentralCrossRefPubMed

17.

Pletz MW, Lipman J. Clinical measures for increased creatinine clearances and suboptimal antibiotic dosing. Intensive Care Med. 2013;39(7):1322–4. doi:10.1007/s00134-013-2918-8.CrossRefPubMed

18.

Udy AA, Morton FJ, Nguyen-Pham S, Jarrett P, Lassig-Smith M, Stuart J, et al. A comparison of CKD-EPI estimated glomerular filtration rate and measured creatinine clearance in recently admitted critically ill patients with normal plasma creatinine concentrations. BMC Nephrol. 2013;14:250. doi:10.1186/1471-2369-14-250.PubMedCentralCrossRefPubMed

19.

Conil JM, Georges B, Mimoz O, Dieye E, Ruiz S, Cougot P, et al. Influence of renal function on trough serum concentrations of piperacillin in intensive care unit patients. Intensive Care Med. 2006;32(12):2063–6. doi:10.1007/s00134-006-0421-1.CrossRefPubMed

20.

Georges B, Conil JM, Ruiz S, Seguin T, Cougot P, Fourcade O, et al. Ceftazidime dosage regimen in intensive care unit patients: from a population pharmacokinetic approach to clinical practice via Monte Carlo simulations. Br J Clin Pharmacol. 2012;73(4):588–96. doi:10.1111/j.1365-2125.2011.04117.x.PubMedCentralCrossRefPubMed

21.

Udy AA, Roberts JA, Lipman J. Implications of augmented renal clearance in critically ill patients. Nat Rev Nephrol. 2011;7(9):539–43. doi:10.1038/nrneph.2011.92.PubMed

22.

Larsson R, Bodemar G, Kagedal B, Walan A. The effects of cimetidine (Tagamet) on renal function in patients with renal failure. Acta Med Scand. 1980;208(1–2):27–31.PubMed

23.

Hull JH, Hak LJ, Koch GG, Wargin WA, Chi SL, Mattocks AM. Influence of range of renal function and liver disease on predictability of creatinine clearance. Clin Pharmacol Ther. 1981;29(4):516–21.CrossRefPubMed

24.

Miller WG, Myers GL, Ashwood ER, Killeen AA, Wang E, Thienpont LM, et al. Creatinine measurement: state of the art in accuracy and interlaboratory harmonization. Arch Pathol Lab Med. 2005;129(3):297–304. doi:10.1043/1543-2165(2005)129<297:CMSOTA>2.0.CO;2.PubMed

25.

Mosteller RD. Simplified calculation of body-surface area. New Engl J Med. 1987;317(17):1098. doi:10.1056/NEJM198710223171717.PubMed

26.

Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974;8:650–5.

27.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.CrossRefPubMed

28.

Sheiner LB, Beal SL. Some suggestions for measuring predictive performance. J Pharmacokinet Biopharm. 1981;9(4):503–12.CrossRefPubMed

29.

Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology. 2011;115(2):231–41. doi:10.1097/ALN.0b013e318225b80a.CrossRefPubMed

30.

Lemeshow S, Hosmer DW Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115(1):92–106.PubMed

31.

Conil JM, Georges B, Fourcade O, Seguin T, Lavit M, Samii K, et al. Assessment of renal function in clinical practice at the bedside of burn patients. Br J Clin Pharmacol. 2007;63(5):583–94. doi:10.1111/j.1365-2125.2006.02807.x.PubMedCentralCrossRefPubMed

32.

Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R, et al. Comparison of drug dosing recommendations based on measured GFR and kidney function estimating equations. Am J Kidney Dis Off J National Kidney Found. 2009;54(1):33–42. doi:10.1053/j.ajkd.2009.03.008.CrossRef

33.

Carlier M, Carrette S, Roberts JA, Stove V, Verstraete AG, Hoste E, et al. Meropenem and piperacillin/tazobactam prescribing in critically ill patients: does augmented renal clearance affect pharmacokinetic/pharmacodynamic target attainment when extended infusions are used? Crit Care. 2013;17(3):R84. doi:10.1186/cc12705.PubMedCentralCrossRefPubMed

34.

Claus BO, Hoste EA, Colpaert K, Robays H, Decruyenaere J, De Waele JJ. Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy. J Crit Care. 2013;. doi:10.1016/j.jcrc.2013.03.003.

35.

Conil JM, Georges B, Lavit M, Seguin T, Tack I, Samii K, et al. Pharmacokinetics of ceftazidime and cefepime in burn patients: the importance of age and creatinine clearance. Int J Clin Pharmacol Ther. 2007;45(10):529–38.CrossRefPubMed

36.

Conil JM, Georges B, de Lussy A, Khachman D, Seguin T, Ruiz S, et al. Ciprofloxacin use in critically ill patients: pharmacokinetic and pharmacodynamic approaches. Int J Antimicrob Agents. 2008;32(6):505–10. doi:10.1016/j.ijantimicag.2008.05.019.CrossRefPubMed

37.

Goncalves-Pereira J, Povoa P. Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of beta-lactams. Crit Care. 2011;15(5):R206. doi:10.1186/cc10441.PubMedCentralCrossRefPubMed

38.

Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, Greene T, et al. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem. 2006;52(1):5–18. doi:10.1373/clinchem.2005.0525144.CrossRefPubMed

39.

Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function–measured and estimated glomerular filtration rate. New Engl J Med. 2006;354(23):2473–83. doi:10.1056/NEJMra054415.CrossRefPubMed

40.

Bragadottir G, Redfors B, Ricksten SE. Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury–true GFR versus urinary creatinine clearance and estimating equations. Crit Care. 2013;17(3):R108. doi:10.1186/cc12777.PubMedCentralCrossRefPubMed

41.

Kim KE, Onesti G, Swartz C. Creatinine clearance and glomerular filtration rate. Br Med J. 1972;1(5796):379–80.PubMedCentralCrossRefPubMed

42.

Tynkevich E, Flamant M, Haymann JP, Metzger M, Thervet E, Boffa JJ, et al. Decrease in urinary creatinine excretion in early stage chronic kidney disease. PLoS One. 2014;9(11):e111949. doi:10.1371/journal.pone.0111949.PubMedCentralCrossRefPubMed

43.

Conil JM, Georges B, Breden A, Ruiz S, Cougot P, Fourcade O, et al. Estimation of glomerular filtration rate to adjust vancomycin dosage in critically ill patients: superiority of the Chronic Kidney Disease Epidemiology Collaboration equation? Anaesth Intensive Care. 2014;42(2):178–84.PubMed

Title: Screening of patients with augmented renal clearance in ICU: taking into account the CKD-EPI equation, the age, and the cause of admission
Authors: Stéphanie Ruiz
Vincent Minville
Karim Asehnoune
Marie Virtos
Bernard Georges
Olivier Fourcade
Jean-Marie Conil
Publication date: 01-12-2015
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2015
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-015-0090-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Screening of patients with augmented renal clearance in ICU: taking into account the CKD-EPI equation, the age, and the cause of admission

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Insights and limits of translational research in critical care medicine

Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation

Extravascular lung water in critical care: recent advances and clinical applications

Prolonged prone positioning under VV-ECMO is safe and improves oxygenation and respiratory compliance

Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications

Low-dose corticosteroid treatment and mortality in refractory abdominal septic shock after emergency laparotomy