2019
DOI: 10.1016/j.xkme.2019.06.002
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Estimating Creatinine Clearance in the Nonsteady State: The Determination and Role of the True Average Creatinine Concentration

Abstract: Creatinine clearance is a tenet of nephrology practice. However, with just a single creatinine concentration included in the denominator of the creatinine clearance equation, the resulting value seems to apply only in the steady state. Does the basic clearance formula work in the nonsteady state, and can it recapitulate the kinetic glomerular filtration rate (GFR) equation? In the kinetic state, a nonlinear creatinine trajectory is reducible into a "true average" value that can be found using calculus, proceed… Show more

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Cited by 9 publications
(14 citation statements)
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References 30 publications
(59 reference statements)
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“…(1) The original algebraic equation which uses the mean of the 2 Cr values has been used. The later calculus version uses the true average value of Cr based on a differential equation and as such is likely to be more accurate [11,12]. (2) The V d used in this study was fixed for each patient derived from baseline data and may not accurately reflect the changes in V d over the 48-h period.…”
Section: Discussion/conclusionmentioning
confidence: 99%
“…(1) The original algebraic equation which uses the mean of the 2 Cr values has been used. The later calculus version uses the true average value of Cr based on a differential equation and as such is likely to be more accurate [11,12]. (2) The V d used in this study was fixed for each patient derived from baseline data and may not accurately reflect the changes in V d over the 48-h period.…”
Section: Discussion/conclusionmentioning
confidence: 99%
“…The creatinine serves mostly as a surrogate to calculate the GFR. The [creatinine] is relatable to the GFR by a differential equation (Chen, 2018a;Chen & Chiaramonte, 2019). The rate of change in the creatinine amount is a function of the rate of creatinine coming in minus the rate of creatinine going out of its volume of distribution, which is total body water (TBW) (Chow, 1985;Edwards, 1959;Jones & Burnett, 1974;Pickering et al, 2013).…”
Section: Kinetic Gfr Equationmentioning
confidence: 99%
“…where [Cr] 0 is the initial serum [creatinine] for each clinical time interval (Chen, 2018a;Chen & Chiaramonte, 2019). That is to say, the serum [creatinine] at a given time is equal to the initial [creatinine] plus a time-evolved portion of the spread between the initial [creatinine] and the [creatinine] reached at a new steady state if the kinetic GFR and volume change rate remained at those levels.…”
Section: Kinetic Gfr Equationmentioning
confidence: 99%
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“…The differential equation that underpins the kinetic GFR states that the rate of change in the creatinine mass is equal to the creatinine input rate minus the creatinine output rate (Chen, 2018a , 2018b ; Chen & Chiaramonte, 2019 ). Further, the creatinine mass at any given time is the current [creatinine] times the volume of distribution, typically taken to be total body water (TBW) (Bjornsson, 1979 ; Chow, 1985 ; Edwards, 1959 ; Jones & Burnett, 1974 ; Pickering et al, 2013 ).…”
Section: Introductionmentioning
confidence: 99%