title: A simple method to detect recovery of glomerular filtration rate following acute kidney injury.
abstract: In acute kidney injury (AKI), elevated plasma creatinine is diagnostic of an earlier loss of glomerular filtration rate (GFR) but not of the concomitant GFR. Only subsequent creatinine changes will inform if GFR had already recovered or not. We hypothesized that the creatinine excretion rate to production rate ratio would provide this information. A retrospective analysis of 482 critically ill patients from two intensive care units (ICU) is shown. Plasma creatinine was measured on ICU entry and 12 hours later. Four-hour creatinine excretion rates (E) were measured on entry. Creatinine production rates were estimated (eG). The ability of the ratio E/eG to predict a decrease in plasma creatinine concentration, identify recovered AKI (≥0.3 mg/dL decrease), and predict AKI (≥0.3 mg/dL increase) was assessed by the area under the receiver operator characteristic curves (AUC). There was a linear relationship between reduced creatinine concentration and E/eG (r (2) = 0.15; P < 0.0001). E/eG predicted a decrease in creatinine (AUC 0.70 (0.65 to 0.74)), identified recovered AKI (0.75 (0.67 to 0.84)), and predicted AKI (0.80 (0.73 to 0.86)). A ratio of the rates of creatinine excretion to estimated production much less than 1 indicated a concomitant GFR below baseline, whereas a ratio much more than 1 indicated a recovering or recovered GFR.
authors: Department of Medicine, University of Otago Christchurch, P.O. Box 4345, Christchurch 8140, New Zealand.
authors: John W
authors: JW
authors: Pickering
authors: St. Mary's Health Center, Department of Internal Medicine, 6420 Clayton Road, St. Louis, MO 63117, USA.
authors: John
authors: 0000-0003-3713-5737
authors: J
authors: Mellas
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000503:physiopathology*; D019540:Area Under Curve; D003404:Creatinine / Q000097:blood; D003710:Demography; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007362:Intensive Care Units; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D016896:Treatment Outcome
chemical_list: D003404:Creatinine