Assessment of renal function in recently admitted critically ill patients with normal serum creatinine

Hoste, Eric; Damen, Jorn; Vanholder, Raymond; Lameire, Norbert; Delanghe, Joris; Hauwe, Kristof Van den; Colardyn, Francis

doi:10.1093/ndt/gfh707

Cited by 185 publications

(168 citation statements)

References 17 publications

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“…Even if some authors found that these formulas were not optimal for recently admitted critically ill patients (17), the MDRD equation has been found superior to Cockcroft-Gault formulas in renal transplant recipients (30), for predicting aminoglycoside dosing recommendations (5), and in the general population (37).…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Georges¹,

Conil²,

Seguin³

et al. 2009

Antimicrob Agents Chemother

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The aim of this study was to develop a population-pharmacokinetic model of ceftazidime in intensive care unit patients to include the influence of patients' characteristics on the pharmacokinetics. Forty-nine patients for model building and 23 patients for validation were included in a randomized study. They received ceftazidime at 2 g three times a day or as 6 g per day continuously. A NONMEM pharmacokinetic model was constructed, and the influences of covariates were studied. The model was validated by a comparison of the predicted and observed concentrations. A final model was elaborated from the whole population. Total clearance (CL) was significantly correlated with the glomerular filtration rate (GFR) calculated by modification of the diet in renal disease (MDRD), the central volume of distribution (V1) with intubation, and the peripheral volume of distribution (V2) with the reason for admission. The mean pharmacokinetic parameters were as follows: CL, 5.48 liters/h, 40%; V1, 10.48 liters, 34%; V2, 32.12 liters, 59%; total volume, 42.60 liters, 45%; and intercompartmental clearance, 16.19 liters/h, 42%. In the polytrauma population (mechanically ventilated), the time above the MIC at steady state never corresponds to 100% for discontinuous administration, and the target concentration of five times the MIC was reached with a 6-g/day dose only for patients with an MDRD of <150 ml/min. We showed that the GFR-MDRD, mechanical ventilation, and the reason for admission may influence the achieved concentrations of ceftazidime. Our model allows the a priori dosing to be adjusted to the individual patient.

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Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Georges¹,

Conil²,

Seguin³

et al. 2009

Antimicrob Agents Chemother

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“…However, several limitations exist to the use of CCr in ICU patients. For instance, CCr will often over estimate GFR, especially in patients with AKI, as creatinine is also excreted in the tubules, and establishing steady state conditions is often not possible [30][31][32] .…”

Section: Management Of Persistent Akimentioning

confidence: 99%

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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“…Hoste et al (18) reported that 25% of patients who were in the ICU and had a normal serum creatinine value (Ͻ1.5 mg/dl) had an estimated GFR Ͻ60 ml/min per 1.73 m 2 as measured with a 1-h creatinine clearance. Of interest, the patients with the low creatinine clearance had a low creatinine generation and were more likely to be ventilated and on vasopressors.…”

Section: Defining Patients At Risk For Acute Renal Injurymentioning

confidence: 99%

“…Some of the problems that are encountered with serum creatinine can be avoided by the use of clearance determinations that are based on timed urinary collections over 1 or 2 h, with blood sampling in the middle to cover potential changes in serum creatinine (18,29,30). This method can be performed accurately only when urine collections occur with an indwelling bladder catheter, but the "GFR" that is based on this measurement still can be inserted into the RIFLE criteria, because a GFR decrease of Ͼ25% meets the criteria for a risk classification.…”

Section: Defining Patients At Risk For Acute Renal Injurymentioning

confidence: 99%

Defining Acute Renal Failure

Biesen

Vanholder²,

Lameire³

2006

Clinical Journal of the American Society of Nephrology

157

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The introduction of the RIFLE classification has increased the conceptual understanding of the acute kidney injury (AKI) syndrome, and this classification has been successfully tested in a number of clinical studies. This review discusses the strengths and weaknesses of the RIFLE classification and suggests additional parameters to broaden future definitions of AKI. These definitions should not only focus on kidney function alone, but also include parameters describing the origin of the patient, the most important causal factors responsible for AKI and information on the pre-existing kidney function. This more complete definition should lead to a decrease in the variability of the results of epidemiological studies and of future clinical trials in AKI populations.

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Assessment of renal function in recently admitted critically ill patients with normal serum creatinine

Abstract: In recently admitted critically ill patients with normal serum creatinine, serum creatinine had a low sensitivity for detection of renal dysfunction. Furthermore, the Cockcroft-Gault and MDRD equations were not adequate in assessing renal function.

Cited by 185 publications

References 17 publications

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Population Pharmacokinetics of Ceftazidime in Intensive Care Unit Patients: Influence of Glomerular Filtration Rate, Mechanical Ventilation, and Reason for Admission

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Defining Acute Renal Failure

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