Comparative study of three methods of estimation of creatinine clearance in critically ill patients.
BACKGROUND
At the bedside, the reference method for creatinine clearance determination is based on the measurement of creatinine concentrations in urine and serum (mCrCl). Several models are available to calculate the creatinine clearance from the serum creatinine concentration. This observational survey aimed at testing the hypothesis that the proposed equations are unreliable to determine accurate creatinine clearance in patients admitted to intensive care unit (ICU).


METHODS
Creatinine clearance was determined by the use of mCrCl. Then, we compared three equations: Cockcroft-Gault (CG), Simplified Modification of Diet in Renal Disease (MDRDs), and Chronic Kidney Disease Epidemiology (CKD-EPI) in 156 consecutive patients within the first 24hours after ICU admission. We tested the hypothesis that the three equations were equivalent. The agreement between the three equations was evaluated by linear regression and Bland and Altman analysis.


RESULTS
Bland and Altman analysis showed similar agreement between the three equations. The biases and precisions were -4.8±51, -1.3±50, and 8.2±44 for CG, MDRDs, and CKD-EPI equations, respectively (P>0.05). The precisions were similar for the three equations (P>0.05). The percentages of outliers at ±30% were 44%, 45%, and 49% for CG, MDRDs, and CKD-EPI, respectively (P>0.05).


CONCLUSIONS
Regarding the high percentage of outliers, the use of these equations cannot be recommended in ICU patients.
Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France.
V
V
Blasco
Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France.
F
F
Antonini
Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France.
L
L
Zieleskiewicz
Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France.
E
E
Hammad
Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France.
J
J
Albanèse
Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France.
C
C
Martin
Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France. Electronic address: marc.leone@ap-hm.fr.
M
M
Leone
D000328:Adult; D000465:Algorithms; D003404:Creatinine / Q000097:blood / Q000378:metabolism* / Q000652:urine; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000652:urine; D015203:Reproducibility of Results; D012189:Retrospective Studies
D003404:Creatinine
Clairance; Clearance; Creatinine; Créatinine; Equations; Renal; Rénal; Équations