OriginalConcordancia en pacientes críticos entre las ecuaciones diseñadas para la estimación del filtrado glomerular y el aclaramiento de creatinina en orina de 24 hConcordance in critical patients between the equations designed for the calculation of glomerular filtration rate and 24-hour creatinine clearance
Section snippets
Introducción
El fracaso renal agudo (FRA) representa un problema de primer orden en el ámbito hospitalario, más concretamente en las unidades de cuidados intensivos (UCI), donde la frecuencia de aparición es elevada1, 2. Constituye en sí mismo un factor de mal pronóstico, existe una mayor mortalidad en este grupo de pacientes y también la morbilidad se encuentra aumentada, en especial en lo que se refiere a la prolongación de la estancia hospitalaria y a la necesidad de tratamientos de elevado coste, como
Material y métodos
Estudio observacional realizado en una UCI polivalente de 42 camas en un hospital de tercer nivel mediante el análisis retrospectivo de los datos obtenidos en un estudio prospectivo previo15 diseñado para validar el ClCr de 2 h en pacientes críticos frente al ClCr-24 h. Se incluyó a todos los pacientes mayores de 18 años ingresados en nuestra unidad durante el período de estudio que fueran portadores de una sonda uretral. Se excluyó a los pacientes en anuria, pero no los que presentaban
Resultados
Hemos incluido a 307 pacientes, cuyas características se presentan en la tabla 1. En ellos, el ClCr-24 h medido fue de 109±78 ml/min/1,73 m2, aunque con diferencias significativas entre los pacientes traumatizados y los otros grupos de diagnóstico (p<0,001): trauma: 188±83 ml/min/1,73 m2; cirugía programada: 102±62 ml/min/1,73 m2; trasplante: 95±56 ml/min/1,73 m2; cirugía urgente: 93±71 ml/min/1,73 m2; sepsis: 63±48 ml/min/1,73 m2, y otros: 78±52 ml/min/1,73 m2. El ClCr obtenido mediante las distintas
Discusión
La finalidad de utilizar fórmulas para estimar el FG es poder contar con un método rápido que nos permita establecer pautas de prevención de disfunción renal añadida, especialmente ante daño secundario al uso de fármacos y por contraste. Sin embargo, según muestran nuestros resultados, las fórmulas actualmente disponibles (desarrolladas para la estimación del FG en pacientes crónicos) presentan importantes desviaciones respecto al ClCr cuando se aplican a pacientes de las UCI y, de hecho, no
Bibliografía (41)
- et al.
Epidemiología del fracaso renal agudo en las UCI españolas. Estudio prospectivo multicéntrico FRAMI
Med Intensiva
(2006) - et al.
Biomarkers for the diagnosis and risk stratification of acute kidney injury: A systematic review
Kidney Int
(2008) - et al.
Performance of the Cockroft-Gault and Modification of Diet in Renal Disease equations in estimating GFR in ill hospitalized patients
Am J Kidney Dis
(2005) - et al.
Variation in the serum creatinine assay calibration: A practical application to glomerular filtration rate estimation
Kidney Int
(2005) - et al.
The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings
Kidney Int
(1998) - et al.
Acute renal failure in critically ill patients: A multinational, multicenter study
JAMA
(2005) - et al.
Acute kidney injury criteria predict outcomes of critically ill patients
Crit Care Med
(2008) - et al.
Epidemiology of acute kidney injury: How big is the problem?
Crit Care Med
(2008) - et al.
Acute renal failure: Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group
Crit Care Med
(2004) - et al.
Acute Kidney Injury Network (AKIN): Report of an initiative to improve outcomes in acute kidney injury
Crit Care
(2007)
A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients
Nephrol Dial Transplant
A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients
Nephrol Dial Transplant
Rifle criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis
Crit Care
Acute kidey injury in the intensive care unit according to RIFLE
Crit Care Med
Newly developed techniques to study and diagnose acute renal failure
J Am Soc Nephrol
Assesing kidney function. Measured and estimated glomerular filtration rate
N Engl J Med
Replacement of 24-h creatinine clearance by 2-h creatinina clearance in intensive care unit patients: A single center study
Intensive Care Med
Prediction of creatinine clearance from serum creatinine
Nephron
A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation
Ann Intern Med
A simplified equation to predict glomerular filtration rate from serum creatinine
J Am Soc Nephrol
Cited by (17)
Concordance between glomerular filtration rate estimation equations and 4-hour urinary creatinine clearance in critically ill patients with severe trauma
2023, Revista Espanola de Anestesiologia y ReanimacionAcute kidney injury: Renal disease in the ICU
2016, Medicina IntensivaCitation Excerpt :Different equations have been developed to estimate GFR based on isolated samples of SCr without needing to collect urine. Yet, all equations have been shown to have a poor performance in critical care patients, and there is general agreement against its use in this scenario.14–16 Nevertheless, these equations are still a useful guide for drug dosing in renal dysfunction in ICU patients.17
Prevalence of acute kidney injury in intensive care units: The "COrte de prevalencia de disFunción RenAl y DEpuración en críticos" point-prevalence multicenter study
2013, Journal of Critical CareCitation Excerpt :Although Crs is being replaced by the RIFLE and AKIN classifications, which are currently the most widely used, both diagnostic methods have shown inconsistencies in their ability to detect AKI [4,5,25]. A widely used alternative is estimating CrCl using equations; however, this strategy is not suitable for critically ill patients [26,27]. Therefore, to minimize the risk of underestimating the incidence of AKI, we finally resorted to measuring CrCl [4,5].
Introduction to drug pharmacokinetics in the critically ill patient
2012, ChestCitation Excerpt :In situations where renal function is changing, serum creatinine levels lag actual renal function, leading to inaccurate estimations of the GFR. Using 24-h urine collection might be a more-accurate measurement of GFR in critically ill patients than using the Cockcroft-Gault or other equations, but data comparing methods for the purposes of drug dosing in critically ill patients are limited.67 The incidence of AKI in critically ill patients ranges from 1% to 25%.
Discrepancies in the RIFLE classification are due to the method used to assess the level of derangement of kidney function
2011, Journal of Critical CareCitation Excerpt :In addition, in this study, the use of short-time collection assures that the sCr value used for calculating RIFLE was the same for the 3 estimates. The use of C-G to calculate the basal CrCl could represent a possible bias in our results, but we selected this equation because it has been validated in general populations and, in our center, has shown a better behavior than the MDRD equation [28]. We addressed this problem by just selecting those patients with a known basal sCr because; even when risking a selection bias, we assured the validity of the basal CrCl estimate (a more serious problem than that derived from a selected population).