title: Overestimation of Glomerular Filtration Rate Among Critically Ill Adults With Hospital-Acquired Oligoanuric Acute Kidney Injury.
abstract: BACKGROUND
  Medication use in the intensive care unit (ICU) depends on creatinine-based glomerular filtration rate (GFR) estimates. Urine output deterioration may precede the creatinine rise resulting in delayed recognition of GFR reductions. Our objective was to quantify the disparity between estimated GFR (eGFR) and true GFR in ICU patients with hospital-acquired oligoanuric acute kidney injury (hAKI).
  
  
  METHODS
  This single-center cohort study examined adults who met the Acute Kidney Injury Network stage III urine output criterion ≥48 hours after ICU admission. True GFR was ≤15 mL/min/1.73 m(2), and eGFR was described by 6 different creatinine-based equations. True GFR and eGFR were compared on the day of hAKI diagnosis and followed for 4 days using multivariable linear regression with generalized estimating equations, adjusting for day and method.
  
  
  RESULTS
  Of the 691 patients screened, we enrolled 61 patients. After adjustment for multiple comparisons and day, there were significant differences in eGFR between the estimation methods and true GFR (P < .001). After day adjustment, eGFR overestimated true GFR by 17 to 50 mL/min/1.73 m(2) and overestimation persisted through the fourth day of hAKI (P ≤ .001).
  
  
  CONCLUSIONS
  Creatinine-based equations overestimated GFR in ICU patients with hAKI. This study highlights a population at risk of medication misadventures in whom systems optimization should be considered.
authors.affiliation: Hospital Pharmacy Services, Mayo Clinic, Rochester, MN, USA frazee.erin@mayo.edu.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Frazee
authors.affiliation: Hospital Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Personett
authors.affiliation: Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wood-Wentz
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Lieske
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kianoush B
authors.initials: KB
authors.lastname: Kashani
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000652:urine*; D000368:Aged; D001002:Anuria / Q000150:complications / Q000652:urine; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine*; D016638:Critical Illness; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged
chemical_list: D003404:Creatinine
keywords: anuria; creatinine clearance; critical illness; glomerular filtration rate; renal failure