Development of glomerular filtration rate monitor based on creatinine kinetic modelling in critically ill patients
Background: Creatinine kinetic denotes that under steady state, creatinine production (G) equals to creatinine excretion rate (E), and if production exceeds excretion, GFR is impaired. Kinetic estimate of GFR (keGFR) offers a more accurate estimate of GFR in the acute settings with rapidly changing...
| Main Authors: | , , , , , |
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| Format: | Monograph |
| Language: | English |
| Published: |
2018
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/67922/ http://irep.iium.edu.my/67922/1/Profile%20of%20Final%20Report_FRGS-15-235-0476.pdf |
| Summary: | Background: Creatinine kinetic denotes that under steady state, creatinine production (G) equals to creatinine excretion rate (E), and if production exceeds excretion, GFR is impaired. Kinetic estimate of GFR (keGFR) offers a more accurate estimate of GFR in the acute settings with rapidly changing kidney functions.
Objectives: We evaluated keGFR and E/eG ratio in diagnosis of AKI and its recovery. We also compared their diagnostic ability to the plasma Cystatin C and NGAL.
Methods: This was a prospective observational study of critically ill patients. Inclusion criteria were patients >18 years old with sepsis and procalcitonin>0.5ng/ml.
Results: 70 patients were recruited. keGFR had the least bias with the mean differences nearest to zero (-18 ml/min) when compared to CrCl. keGFRCr and keGFRCysC were strongly diagnostic of AKI with AUC of 0.93 (0.87 to 0.99). In 39 patients with AKI, 15 recovered within 3 days. In these cases, E/eG ratio strongly predicted AKI recovery (AUC 0.83 (0.69 to 0.97)). The AUC of plasma NGAL were highest for AKI diagnosed by keGFR on Day 1 and Day 2, and by E/eG ratio on Day 3.
Conclusions: In critically ill patients with sepsis, keGFRCr and keGFRCysC had the least bias and fair precision when compared to CrCl. They diagnosed AKI with cut-off points of 77 and 86 ml/min respectively. E/eG ratio was useful for prediction of recovery in patients with AKI. NGAL best diagnosed AKI by keGFR and E/eG ratio. |
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