M Volbeda1, L Hessels1, R A Posma1, S J Bakker2, M W Nijsten3. 1. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 2. Department of Nephrology, University of Groningen, University Medical Center, Groningen, the Netherlands. 3. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: m.w.n.nijsten@umcg.nl.
Abstract
PURPOSE: Baseline urinary creatinine excretion (UCE) is associated with ICU outcome, but its time course is not known. MATERIALS AND METHODS: We determined changes in UCE, plasma creatinine, measured creatinine clearance (mCC) and estimated glomerular filtration (eGFR) in patients with an ICU-stay ≥30d without acute kidney injury stage 3. The Cockcroft-Gault, MDRD (modification of diet in renal disease) and CKD-EPI (chronic kidney disease epidemiology collaboration) equations were used. RESULTS: In 248 patients with 5143 UCEs hospital mortality was 24%. Over 30d, UCE absolutely decreased in male survivors and non-survivors and female survivors and nonsurvivors by 0.19, 0.16, 0.10 and 0.05 mmol/d/d (all P < 0.001). Relative decreases in UCE were similar in all four groups: 1.3, 1.4, 1.2 and 0.9%/d respectively. Over 30d, mCC remained unchanged, but eGFR rose by 31% (CKD-EPI) and 73% (MDRD) and creatinine clearance estimated by Cockcroft-Gault by 59% (all P < 0.001). CONCLUSIONS: Over 1 month of ICU stay, UCE declined by ≥1%/d which may correspond to an equivalent decline in muscle mass. These rates of UCE decrease were similar in survivors, non-survivors, males and females underscoring the intransigent nature of this process. In contrast to measured creatinine clearance, estimates of eGFR progressively rose during ICU stay.
PURPOSE: Baseline urinary creatinine excretion (UCE) is associated with ICU outcome, but its time course is not known. MATERIALS AND METHODS: We determined changes in UCE, plasma creatinine, measured creatinine clearance (mCC) and estimated glomerular filtration (eGFR) in patients with an ICU-stay ≥30d without acute kidney injury stage 3. The Cockcroft-Gault, MDRD (modification of diet in renal disease) and CKD-EPI (chronic kidney disease epidemiology collaboration) equations were used. RESULTS: In 248 patients with 5143 UCEs hospital mortality was 24%. Over 30d, UCE absolutely decreased in male survivors and non-survivors and female survivors and nonsurvivors by 0.19, 0.16, 0.10 and 0.05 mmol/d/d (all P < 0.001). Relative decreases in UCE were similar in all four groups: 1.3, 1.4, 1.2 and 0.9%/d respectively. Over 30d, mCC remained unchanged, but eGFR rose by 31% (CKD-EPI) and 73% (MDRD) and creatinine clearance estimated by Cockcroft-Gault by 59% (all P < 0.001). CONCLUSIONS: Over 1 month of ICU stay, UCE declined by ≥1%/d which may correspond to an equivalent decline in muscle mass. These rates of UCE decrease were similar in survivors, non-survivors, males and females underscoring the intransigent nature of this process. In contrast to measured creatinine clearance, estimates of eGFR progressively rose during ICU stay.
Authors: Raphaël Duivenvoorden; Priya Vart; Marlies Noordzij; Augusto C Soares Dos Santos; Alex B Zulkarnaev; Casper F M Franssen; Dirk Kuypers; Erol Demir; Hormat Rahimzadeh; Julia Kerschbaum; Kitty J Jager; Kultigin Turkmen; Marc H Hemmelder; Marcel Schouten; María Luisa Rodríguez-Ferrero; Marta Crespo; Ron T Gansevoort; Luuk B Hilbrands Journal: Transplantation Date: 2022-04-26 Impact factor: 5.385