GFR estimation is complicated by a high incidence of non-steady-state serum creatinine concentrations at the emergency department.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
13
07
2021
accepted:
14
12
2021
entrez:
29
12
2021
pubmed:
30
12
2021
medline:
18
1
2022
Statut:
epublish
Résumé
Acquiring a reliable estimate of glomerular filtration rate (eGFR) at the emergency department (ED) is important for clinical management and for dosing renally excreted drugs. However, renal function formulas such as CKD-EPI can give biased results when serum creatinine (SCr) is not in steady-state because the assumption that urinary creatinine excretion is constant is then invalid. We assessed the extent of this by analysing variability in SCr in patients who visited the ED of a tertiary care centre. Data from ED visits at the University Medical Centre Utrecht, the Netherlands between 2012 and 2019 were extracted from the Utrecht Patient Oriented Database. Three measurement time points were defined for each visit: last SCr measurement before visit as baseline (SCr-BL), first measurement during visit (SCr-ED) and a subsequent measurement between 6 and 24 hours during admission (SCr-H1). Non-steady-state SCr was defined as exceeding the Reference Change Value (RCV), with 15% decrease or 18% increase between successive SCr measurements. Exceeding the RCV was deemed as a significant change. Of visits where SCr-BL and SCr-ED were measured (N = 47,540), 28.0% showed significant change in SCr. Of 17,928 visits admitted to the hospital with a SCr-H1 after SCr-ED, 27,7% showed significant change. More than half (55%) of the patients with SCr values available at all three timepoints (11,054) showed at least one significant change in SCr over time. One third of ED visits preceded and/or followed by creatinine measurement show non-stable serum creatinine concentration. At the ED automatically calculated eGFR should therefore be interpreted with great caution when assessing kidney function.
Sections du résumé
BACKGROUND
Acquiring a reliable estimate of glomerular filtration rate (eGFR) at the emergency department (ED) is important for clinical management and for dosing renally excreted drugs. However, renal function formulas such as CKD-EPI can give biased results when serum creatinine (SCr) is not in steady-state because the assumption that urinary creatinine excretion is constant is then invalid. We assessed the extent of this by analysing variability in SCr in patients who visited the ED of a tertiary care centre.
METHODS
Data from ED visits at the University Medical Centre Utrecht, the Netherlands between 2012 and 2019 were extracted from the Utrecht Patient Oriented Database. Three measurement time points were defined for each visit: last SCr measurement before visit as baseline (SCr-BL), first measurement during visit (SCr-ED) and a subsequent measurement between 6 and 24 hours during admission (SCr-H1). Non-steady-state SCr was defined as exceeding the Reference Change Value (RCV), with 15% decrease or 18% increase between successive SCr measurements. Exceeding the RCV was deemed as a significant change.
RESULTS
Of visits where SCr-BL and SCr-ED were measured (N = 47,540), 28.0% showed significant change in SCr. Of 17,928 visits admitted to the hospital with a SCr-H1 after SCr-ED, 27,7% showed significant change. More than half (55%) of the patients with SCr values available at all three timepoints (11,054) showed at least one significant change in SCr over time.
CONCLUSION
One third of ED visits preceded and/or followed by creatinine measurement show non-stable serum creatinine concentration. At the ED automatically calculated eGFR should therefore be interpreted with great caution when assessing kidney function.
Identifiants
pubmed: 34965267
doi: 10.1371/journal.pone.0261977
pii: PONE-D-21-22760
pmc: PMC8716053
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0261977Déclaration de conflit d'intérêts
M.S.A. Niemantsverdriet is employed by SkylineDx, Rotterdam. All others have no competing financial interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Références
Clin J Am Soc Nephrol. 2011 Oct;6(10):2411-20
pubmed: 21852668
J Am Soc Nephrol. 2009 Mar;20(3):672-9
pubmed: 19244578
J Investig Med. 2020 Apr;68(4):870-881
pubmed: 32179556
Crit Care. 2013 Feb 04;17(1):204
pubmed: 23394211
Clin Pharmacokinet. 2020 Oct;59(10):1303-1311
pubmed: 32385733
Am J Kidney Dis. 2005 Aug;46(2):242-52
pubmed: 16112042
Arch Intern Med. 2004 Mar 22;164(6):659-63
pubmed: 15037495
Int J Clin Pharmacol Ther. 2010 Sep;48(9):571-6
pubmed: 20860910
J Am Soc Nephrol. 2013 May;24(6):877-88
pubmed: 23704286
Clin Chem Lab Med. 2011 Sep 30;50(5):807-12
pubmed: 21958344
Am J Nephrol. 2015;41(1):81-8
pubmed: 25677982
BMC Nephrol. 2014 May 29;15:84
pubmed: 24885247
Ann Intern Med. 2013 Jun 4;158(11):825-30
pubmed: 23732715
Clin Chem Lab Med. 2007;45(1):13-9
pubmed: 17243908
Am J Nephrol. 2002 Jul-Aug;22(4):320-4
pubmed: 12169862
Clin J Am Soc Nephrol. 2013 Jul;8(7):1070-8
pubmed: 23539228
Clin Chem. 2006 Aug;52(8):1602-3
pubmed: 16873298
Nephrology (Carlton). 2020 Jun;25(6):457-466
pubmed: 31654593
Am J Nephrol. 2012;35(4):349-55
pubmed: 22473149
Semin Nephrol. 2016 Jan;36(1):31-41
pubmed: 27085733
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839