Reliability of serum creatinine‐based formulae estimating renal function in non‐critically ill surgery patients: Focus on augmented renal clearance. (7th May 2018)

• Record Type: Journal Article
• Authors: Declercq, Peter; Gijsen, Matthias; Meijers, Björn; Schetz, Marie; Nijs, Stefaan; D'Hoore, André; Wauters, Joost; Spriet, Isabel
• Is Part Of: Journal of clinical pharmacy and therapeutics. Volume 43:Number 5(2018)
• Page Start: 695
• Page End: 706
• Publication Date: 2018-05-07
• Subjects: agreement analysis -- augmented renal clearance -- non‐critically ill -- renal clearance -- surgery; Clinical pharmacology -- Periodicals; Chemotherapy -- Periodicals; 615
• DOI: 10.1111/jcpt.12695
• Languages: English
• ISSNs: 0269-4727

Abstract

Summary: What is known and objectives: Formulae estimating glomerular filtration rate (GFR) are frequently used to guide drug dosing. The objectives of this prospective single‐center study were to evaluate agreement between these equations and measured creatinine clearance (CrCl) in non‐critically ill surgery patients with normal kidney function and augmented renal clearance (ARC, CrCl ≥ 130 mL/min/1.73 m²), to determine predictors for disagreement, define a GFR estimator cut‐off value identifying ARC and determine the ARC prevalence and duration in non‐critically ill surgical patients. Methods: Hospitalized adult non‐critically ill abdominal and trauma surgery patients were eligible for inclusion. Measured CrCl based on an 8‐hour urinary collection (CrCl8h ) was used as the primary method for determining kidney function. Agreement between equations and measured CrCl8h was assessed in terms of precision, defined as a bias within ±10 mL/min/1.73 m². Predictors for disagreement were identified for the most precise estimator using an ordinal logistic regression model with negative bias, agreement and positive bias as outcome variables. A receiver operating characteristic (ROC) analysis was performed to identify an estimator cut‐off predicting ARC, which was subsequently applied for the daily proportion of patients displaying ARC and ARC duration. Results and discussion: During the study period (14/11/2013 ‐ 13/05/2014), in 232 adult non‐critically ill abdominal and trauma surgery patients, all estimators tend to underestimate CrCl8h (mean bias ranging from 17 to 22 mL/min/1.73 m²), especially in patients displaying ARC (mean bias ranging from 44 to 56 mL/min/1.73 m²). eGFRCKD‐EPI performed the best. Younger age and low ASA score independently predicted underestimation of CrCl8h . Three different eGFRCKD‐EPI cut‐offs with decreasing sensitivity and increasing specificity (84, 95 and 112 mL/min/1.73 m²) identified, respectively, 65%, 44% and 14% patients displaying ARC. The median ARC duration was 4, 4 and 3 days, respectively. What is new and conclusion: In surgical patients, eGFR frequently underestimates measured CrCl, especially in young patients with low ASA score. eGFR cut‐offs predicting ARC were identified. Abstract : Serum creatinine based formulae estimating glomerular filtration rate (eGFR) are frequently used to guide drug dosing. In surgical patients, eGFR frequently underestimates measured creatinine clearance, especially in young patients with low ASA score. eGFR cutoffs predicting ARC were identified.