A Proposed Mechanism for Reduced Creatinine Excretion in Severe Chronic Renal Failure

Mitch, William E.; Walser, Mackenzie

doi:10.1159/000181400

Cited by 98 publications

(55 citation statements)

References 11 publications

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“…In ESRD, as much as 30% of endogenously produced creatinine may be metabolized by gut flora (4), which reduces creatinine appearance rate; however, the latter can be determined by dividing the MCC by the serum creatinine. We also attempted to estimate creatinine generation rates in our study cohort by correcting appearance rates for endogenous creatinine metabolism by gut flora, using the equation 0.3 ϫ Cr ϫ weight (mg metabolized per day) (4). All data are presented as mean Ϯ SD, and values are compared using an unpaired t test.…”

Section: Methodsmentioning

confidence: 99%

The MDRD Equation Predicts Peritoneal Dialysis-Delivered Creatinine Clearances from Serum Creatinine

Khosla

Steiner

2009

Clinical Journal of the American Society of Nephrology

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Results: For the group, the four-variable MDRDE predicted a creatinine clearance of 6.5 ؎ 3.7 ml/min/1.73 m 2 when measured clearance from home collections of dialysate and urine was 6.8 ؎ 3.1 ml/min/1.73 m 2 . The presence or volume of residual urine had no effect on accuracy. The six-variable MDRDE was similarly accurate. Creatinine appearance rates were similar to those reported in other dialysis populations.Conclusions: Using serum creatinine values in "standard" fashion, MDRDEs can approximate creatinine clearances achieved by peritoneal dialysis with an accuracy similar to that of the MDRDEs in predialysis populations, perhaps because the MRDREs account exponentially for the increasing fractional gut metabolism of daily creatinine production as the serum creatinine increases. "MDRD-like" equations may provide a much needed method of directly comparing dialytic clearances to those achieved by diseased native kidneys and by kidney transplants.

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Section: Methodsmentioning

confidence: 99%

The MDRD Equation Predicts Peritoneal Dialysis-Delivered Creatinine Clearances from Serum Creatinine

Khosla

Steiner

2009

Clinical Journal of the American Society of Nephrology

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“…The extrarenal clearance of creatinine in people with normal kidney function is relatively small. However, in patients with CKD, as much as two thirds of total daily creatinine excretion can occur by extrarenal elimination (53). Therefore, falsely elevated GFR values can be associated with the use of creatinine clearance, especially in individuals with chronic renal failure (54).…”

Section: Creatinine-based Measurement Of Gfrsmentioning

confidence: 99%

Measurement and Estimation of GFR in Children and Adolescents

Schwartz

Work

2009

Clinical Journal of the American Society of Nephrology

836

604

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GFR is the best indicator of renal function in children and adolescents and is critical for diagnosing acute and chronic kidney impairment, intervening early to prevent end-stage renal failure, prescribing nephrotoxic drugs and drugs cleared by a failing kidney, and monitoring for side effects of medications. Renal inulin clearance was the gold standard for GFR but is compromised by lack of availability, difficult assays, and problems of collecting timed urine samples, especially in children with vesicoureteral reflux or bladder dysfunction. Creatinine clearance-based estimates of GFR are often used in pediatrics. The addition of cimetidine to eliminate creatinine secretion permits accurate measurement of GFR in those who can completely empty their bladders to provide timed urine collections. Radioisotopes are used in plasma disappearance GFR determinations; however, these are not ideal for use in children, especially for repeated studies. The plasma disappearance of iohexol serves as a promising alternative GFR marker, because it is safe and not radioactive, easily measured, not metabolized or transported by the kidney, and excreted primarily by glomerular filtration. GFR estimating equations, based on serum concentrations of creatinine or cystatin C, are popular clinically and in research studies. Efforts are ongoing to improve these estimating equations for children and make the results readily available to clinicians obtaining standard chemistry profiles, as is being done for adults. However, at this time, there is no dependable substitute for an accurately determined GFR, and iohexol plasma disappearance offers the best combination of safety, accuracy, and reproducible precision.

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“…Total daily creatinine production was measured as the sum of daily creatinine excreted in the dialysate and urine plus the estimated daily creatinine lost in the gut (17). Fat-free edema-free body mass was then computed according to the following equation (18,19): fat-free, edema-free body mass (kg) ϭ 0.029*total creatinine production in mg/d ϩ 7.38.…”

Section: Assessment Of Nutrition Status and Degree Of Inflammationmentioning

confidence: 99%

Resting Energy Expenditure and Subsequent Mortality Risk in Peritoneal Dialysis Patients

Wang¹,

Sea²,

Tang³

et al. 2004

Journal of the American Society of Nephrology

107

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Abstract. Cardiovascular disease is the leading cause of death in ESRD patients and is strongly associated with malnutrition. The mechanism of malnutrition is not clear, but hypermetabolism is suggested to contribute to cardiac cachexia. This study examined resting energy expenditure (REE) in relation to the clinical outcomes of ESRD patients who receive continuous ambulatory peritoneal dialysis (CAPD) treatment. A prospective observational cohort study was performed in 251 CAPD patients. REE was measured at study baseline using indirect calorimetry together with other clinical, nutritional, and dialysis parameters. Patients were followed up for a mean Ϯ SD duration of 28.7 Ϯ 14.3 mo. REE was 39.1 Ϯ 9.6 and 40.1 Ϯ 9.0 kcal/kg fat-free edema-free body mass per day for men and women, respectively (P ϭ 0.391). Using multiple regression analysis, fat-free edema-free body mass-adjusted REE was negatively associated with residual GFR (P Ͻ 0.001) and serum albumin (P ϭ 0.046) and positively associated with diabetes (P ϭ 0.002), cardiovascular disease (P ϭ 0.009), and C-reactive protein (P ϭ 0.009). At 2 yr, the overall survival was 63.3, 73.6, and 95.9% (P Ͻ 0.0001), and cardiovascular event-free survival was 72.3, 84.6, and 97.2% (P ϭ 0.0003), respectively, for patients in the upper, middle, and lower tertiles of REE. Adjusting for age, gender, diabetes, and cardiovascular disease, patients in the upper and middle tertiles showed a 4.19-fold (95% confidence interval, 2.15 to 8.16; P Ͻ 0.001) and a 2.90-fold (95% confidence interval, 1.49, 5.63; P ϭ 0.002) respective increase in the risk of all-cause mortality compared with those in the lower tertile. However, the significance of REE in predicting mortality was gradually reduced when additional adjustment was made for C-reactive protein, serum albumin, and residual GFR in a stepwise manner. In conclusion, a higher REE is associated with increased mortality and cardiovascular death in CAPD patients and is partly related to its close correlations with residual kidney function, cardiovascular disease, inflammation, and malnutrition in these patients.Malnutrition is usually the consequence of energy imbalance and can be attributed to changes in dietary intake or energy expenditure or both. Sustained hypermetabolism can lead to energy imbalance and wasting if not compensated for by an increase in energy intake. Indeed, hypermetabolism was suggested to be one of the contributory factors for cachexia in disease states such as cardiac failure (1), chronic obstructive pulmonary disease (2), and malignancy (3,4). However, its association with protein-energy malnutrition in ESRD patients has not been established. Protein-energy malnutrition is a significant complication and predicts mortality in ESRD patients (5,6). However, malnutrition is well known to be associated with inflammation and atherosclerotic vascular disease in ESRD patients (7,8). Whereas the severity of inflammation as denoted by the acute-phase response or proinflammatory cytokine is related to resting hypermetab...

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A Proposed Mechanism for Reduced Creatinine Excretion in Severe Chronic Renal Failure

Cited by 98 publications

References 11 publications

The MDRD Equation Predicts Peritoneal Dialysis-Delivered Creatinine Clearances from Serum Creatinine

The MDRD Equation Predicts Peritoneal Dialysis-Delivered Creatinine Clearances from Serum Creatinine

Measurement and Estimation of GFR in Children and Adolescents

Resting Energy Expenditure and Subsequent Mortality Risk in Peritoneal Dialysis Patients

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