title: Comparison of different equations to assess glomerular filtration in critically ill patients.
abstract: OBJECTIVE
  To evaluate equations for estimation of glomerular filtration rate (GFR) and measured urinary creatinine clearance, compared to measured GFR in critically ill patients.
  
  
  METHODS
  GFR was measured using inulin clearance. Multiple blood samples were collected per patient for determination of serum creatinine, cystatin C and inulin. GFR was estimated by the use of the following estimation equations (eGFR): four commonly used creatinine-based equations [Cockcroft-Gault, Modification of Diet in Renal Disease (both the short and long formula) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)], five cystatin C based estimation equations (Hoek, Larsson, Filler, Le Bricon, CKD-EPIcys) and one equation combining cystatin C and serum creatinine (CKD-EPIcr-cys). In addition we measured urinary creatinine clearance. Bias, precision and accuracy of all estimates were compared to those of the inulin clearance.
  
  
  RESULTS
  Data were collected from 83 patients, of whom 68 were considered evaluable. The median age was 58 years [interquartile range (IQR) 39-68]. The median inulin clearance was 80 mL/min/1.73 m(2) (IQR 31-114). Equations based on creatinine had much bias and poor precision and accuracy. Measured urinary creatinine clearances overestimated GFR. Equations based on cystatin C were free of bias, but also had limited precision and accuracy.
  
  
  CONCLUSIONS
  In this cohort of patients, estimates of GFR had low accuracy and precision. Cystatin C based formulas, especially CKD-EPIcr-cys, showed limited bias; however, the accuracy and precision of these estimates were still insufficient. Measured urinary creatinine clearance overestimates GFR, but may provide a cheap alternative, when this is taken into account.
authors.affiliation: Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium, mieke.carlier@ugent.be.
authors.forename: Mieke
authors.initials: M
authors.lastname: Carlier
authors.forename: Alexander
authors.initials: A
authors.lastname: Dumoulin
authors.forename: Alexander
authors.initials: A
authors.lastname: Janssen
authors.forename: Sven
authors.initials: S
authors.lastname: Picavet
authors.forename: Steve
authors.initials: S
authors.lastname: Vanthuyne
authors.forename: Ria
authors.initials: R
authors.lastname: Van Eynde
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.forename: Joris
authors.initials: J
authors.lastname: Delanghe
authors.forename: Gert
authors.initials: G
authors.lastname: De Schoenmakere
authors.forename: Jan J
authors.initials: JJ
authors.lastname: De Waele
authors.forename: Eric A J
authors.initials: EA
authors.lastname: Hoste
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000097:blood / Q000652:urine; D016638:Critical Illness; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007362:Intensive Care Units; D007444:Inulin / Q000097:blood; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D007444:Inulin; D003404:Creatinine