title: Screening of patients with augmented renal clearance in ICU: taking into account the CKD-EPI equation, the age, and the cause of admission.
abstract: BACKGROUND
  In ICU patients with normal serum creatinine (SCr), a state of increased renal drug excretion has been described (creatinine clearance ≥130 ml/min/1.73 m(2)), and named augmented renal clearance (ARC). In ICU patients, the accuracy of GFR estimates is insufficient. However, in clinical practice, the physician has not at one's disposal patient measured creatinine clearance (CrCl) when prescribing. The primary objective of this study was to assess the accuracy of 4 formulas to estimate GFR (Cockcroft-Gault (CG), Robert, sMDRD, and CKD-EPI formulas) with other covariates to detect ARC in ICU patients.
  
  
  METHODS
  We enroled 360 consecutive ICU patients with normal SCr in this prospective observational study conducted in a primary teaching hospital. Comparisons between CrCl values and 4 estimated GFR (eGFR) formulas were estimated.
  
  
  RESULTS
  In these 360 patients, ARC was observed in 33 % of patients most of them trauma. Individual predictive values of equations were poor and the phenomenon increased in ARC subgroup. CG and CKD-EPI were more accurate to detect an ARC. Multivariable analysis showed that the best-fitting model included 3 factors independently correlated to ARC: trauma patients, cut-off values of age ≤58 years, and CKD-EPI more than 108 ml/min/1.73 m(2).
  
  
  CONCLUSIONS
  In ICU patients with normal SCr, eGFR formulas are imprecise in assessing CrCl. If measured CrCl must be ideally used to detect modifications of the renal function, in clinical practice, age, reason for admission, and CKD-EPI could be used as screening tool to identify ARC.
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse III Paul Sabatier, Toulouse, France. ruiz.stephanie@chu-toulouse.fr.
authors.forename: Stéphanie
authors.identifier: http://orcid.org/0000-0003-3111-5938
authors.initials: S
authors.lastname: Ruiz
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse III Paul Sabatier, Toulouse, France. minville.v@chu-toulouse.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.affiliation: Service d'Anesthésie Réanimation, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France. karim.asehnoune@chu-nantes.fr.
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse III Paul Sabatier, Toulouse, France. virtos.m@chu-toulouse.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Virtos
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse III Paul Sabatier, Toulouse, France. georges.b@chu-toulouse.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Georges
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse III Paul Sabatier, Toulouse, France. fourcade.o@chu-toulouse.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse III Paul Sabatier, Toulouse, France. conil.jm@chu-toulouse.fr.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Conil
keywords: Critically ill patients; GFR estimations; Measured creatinine clearance; Screening ARC