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Reliability of serum creatinine‐based formulae estimating renal function in non‐critically ill surgery patients: Focus on augmented renal clearance
Author(s) -
Declercq Peter,
Gijsen Matthias,
Meijers Björn,
Schetz Marie,
Nijs Stefaan,
D'Hoore André,
Wauters Joost,
Spriet Isabel
Publication year - 2018
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12695
Subject(s) - renal function , medicine , receiver operating characteristic , critically ill , logistic regression , creatinine , urology , surgery
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 (CrCl 8h ) was used as the primary method for determining kidney function. Agreement between equations and measured CrCl 8h 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 CrCl 8h (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). eGFR CKD‐EPI performed the best. Younger age and low ASA score independently predicted underestimation of CrCl 8h . Three different eGFR CKD‐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.