Evaluation of glomerular filtration rate using iohexol plasma clearance in critically ill patients with augmented renal creatinine clearance

碘海索 肾功能 医学 泌尿科 肌酐 肾脏疾病 血浆清除率 四分位间距 间隙 内科学 药代动力学
作者
Magalie Collet,D. Hijazi,Pauline Sevrain,Romain Barthélémy,Marc‐Antoine Labeyrie,Dominique Prié,Nahid Tabibzadeh,Alexandre Mebazaa,Benjamin G. Chousterman
出处
期刊:European Journal of Anaesthesiology [Ovid Technologies (Wolters Kluwer)]
卷期号:38 (6): 652-658 被引量:11
标识
DOI:10.1097/eja.0000000000001501
摘要

BACKGROUND Augmented renal creatinine clearance (ARC) (≥130 ml min −1 1.73 m −2 ) is frequent in intensive care unit (ICU) patients and may impact patient outcome. OBJECTIVES To compare glomerular filtration rate (GFR) measured with iohexol plasma clearance and creatinine clearance in critically ill patients with augmented renal clearance. DESIGN Single-centre, retrospective study. SETTING French University Hospital ICU from November 2016 to May 2019. PATIENTS Adult patients with augmented renal clearance who had a measurement of iohexol plasma clearance. MAIN OUTCOME MEASURE Agreement between 6 h creatinine clearance (6 h CrCl) and iohexol plasma clearance (GFRio). RESULTS Twenty-nine patients were included. The median 6 h creatinine clearance was 195 [interquartile range (IQR) 162 to 251] ml min −1 1.73 m −2 and iohexol clearance was 133 [117 to 153] ml min −1 1.73 m −2 . Sixteen patients (55%) had hyperfiltration (clearance >130 ml min −1 1.73 m −2 ) measured with iohexol clearance. Mean bias between iohexol and creatinine clearance was −80 [limits of agreement (LoA) −216 to 56 ml min −1 1.73 m −2 ]. For Cockcroft and Gault Modification of Diet in Renal Disease equation (MDRD), Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) formulae, mean biases were, respectively −27 (LoA −99 to 45), −14 (LoA −86 to 59) and 15 (LoA −33 to 64) ml min −1 1.73 m −2 . CONCLUSION In the present study, we found that in patients with augmented renal creatinine clearance, half of the patients do not have hyperfiltration using iohexol clearance measurements. We observed an important bias between 6 h CrCl and GFRio with large LoA. In critically patients with ARC, 6 h CrCl does not reliably estimate GFR and 6 h CrCl nearly systematically overestimates renal function. Comparison of creatinine-based GFR estimations and GFRio show acceptable bias but wide LoA.

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