TY - JOUR
T1 - Overestimation of Glomerular Filtration Rate among Critically Ill Adults with Hospital-Acquired Oligoanuric Acute Kidney Injury
AU - Frazee, Erin N.
AU - Personett, Heather A.
AU - Wood-Wentz, Christina M.
AU - Herasevich, Vitaly
AU - Lieske, John C.
AU - Kashani, Kianoush B.
N1 - Publisher Copyright:
© SAGE Publications.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background: Medication use in the intensive care unit (ICU) depends on creatinine-based glomerular filtration rate (GFR) estimates. Urine output deterioration may precede the creatinine rise resulting in delayed recognition of GFR reductions. Our objective was to quantify the disparity between estimated GFR (eGFR) and true GFR in ICU patients with hospital-acquired oligoanuric acute kidney injury (hAKI). Methods: This single-center cohort study examined adults who met the Acute Kidney Injury Network stage III urine output criterion ≥48 hours after ICU admission. True GFR was ≤15 mL/min/1.73 m2, and eGFR was described by 6 different creatinine-based equations. True GFR and eGFR were compared on the day of hAKI diagnosis and followed for 4 days using multivariable linear regression with generalized estimating equations, adjusting for day and method. Results: Of the 691 patients screened, we enrolled 61 patients. After adjustment for multiple comparisons and day, there were significant differences in eGFR between the estimation methods and true GFR (P <.001). After day adjustment, eGFR overestimated true GFR by 17 to 50 mL/min/1.73 m2 and overestimation persisted through the fourth day of hAKI (P ≤.001). Conclusion: Creatinine-based equations overestimated GFR in ICU patients with hAKI. This study highlights a population at risk of medication misadventures in whom systems optimization should be considered.
AB - Background: Medication use in the intensive care unit (ICU) depends on creatinine-based glomerular filtration rate (GFR) estimates. Urine output deterioration may precede the creatinine rise resulting in delayed recognition of GFR reductions. Our objective was to quantify the disparity between estimated GFR (eGFR) and true GFR in ICU patients with hospital-acquired oligoanuric acute kidney injury (hAKI). Methods: This single-center cohort study examined adults who met the Acute Kidney Injury Network stage III urine output criterion ≥48 hours after ICU admission. True GFR was ≤15 mL/min/1.73 m2, and eGFR was described by 6 different creatinine-based equations. True GFR and eGFR were compared on the day of hAKI diagnosis and followed for 4 days using multivariable linear regression with generalized estimating equations, adjusting for day and method. Results: Of the 691 patients screened, we enrolled 61 patients. After adjustment for multiple comparisons and day, there were significant differences in eGFR between the estimation methods and true GFR (P <.001). After day adjustment, eGFR overestimated true GFR by 17 to 50 mL/min/1.73 m2 and overestimation persisted through the fourth day of hAKI (P ≤.001). Conclusion: Creatinine-based equations overestimated GFR in ICU patients with hAKI. This study highlights a population at risk of medication misadventures in whom systems optimization should be considered.
KW - anuria
KW - creatinine clearance
KW - critical illness
KW - glomerular filtration rate
KW - renal failure
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U2 - 10.1177/0897190014549841
DO - 10.1177/0897190014549841
M3 - Article
C2 - 25326198
AN - SCOPUS:84962517263
SN - 0897-1900
VL - 29
SP - 125
EP - 131
JO - Journal of Pharmacy Practice
JF - Journal of Pharmacy Practice
IS - 2
ER -