Time course of plasma urea and urinary urea excretion in patients with a prolonged ICU stay.
Catabolism
ICU
Urea
Urea-to-creatinine ratio
Urinary creatinine excretion
Urinary urea excretion
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
28 10 2024
28 10 2024
Historique:
received:
21
02
2024
accepted:
26
09
2024
medline:
29
10
2024
pubmed:
29
10
2024
entrez:
29
10
2024
Statut:
epublish
Résumé
Whereas urinary creatinine excretion (UCE) is an established marker of muscle mass, both in critically ill and non-critically ill patients, analysis of urinary urea excretion (UUE) may allow estimation of proteolysis that is associated with critical illness. We evaluated the time courses of plasma urea and creatinine as well UUE and UCE in critically ill patients with a prolonged ICU stay. Our goal was to evaluate changes in plasma urea and creatinine in conjunction with their urinary excretion, to get a better understanding of urea handling in ICU patients. From 2002 to 2021, plasma urea and creatinine, UUE and UCE were determined in routinely obtained 24 h urine samples between ICU admission and day 30, in adult patients with an ICU-stay ≥ 28d. Urea-to-creatinine ratios in plasma and urine were calculated. Patients with stage 3 acute kidney injury (AKI) were excluded. Analyses were performed separately for females and males and for patients with and without acute renal failure to account for respectively differences in muscle mass and impaired renal function. Of 47,120 patients, who were admitted to the ICU between 2002 and 2021, 638 patients met the inclusion criteria. During the first 10 days mean ± SD plasma urea increased from 9.7 ± 6.0 mmol/L at ICU admission to 12.4 ± 7.9 mmol/L (P < 0.001) on day 11 and decreased afterwards with a rate of 0.1 mmol/l/d. UUE peaked at 590 ± 317 mmol/day on day 13 whereas UCE peaked already on day 4. Males had higher plasma urea, plasma creatinine, UUE and UCE than females. Plasma and urinary urea-to-creatinine ratio (UCR) stabilized after day 7, with a gradual increase in plasma UCR and urinary UCR between day 7 and day 30. Similar courses, although less pronounced, were seen in patients without AKI. The course of urea in critically ill patients is characterized by an initial rise of both plasma urea and urinary urea excretion, presumably due to increased catabolism of endogenous and exogenous protein in the first week of ICU admission. Subsequently, UUE and UCE declined steadily in a rate that was comparable to the known loss of muscle mass during ICU admission of approximately 1%/day.
Identifiants
pubmed: 39468058
doi: 10.1038/s41598-024-74579-y
pii: 10.1038/s41598-024-74579-y
doi:
Substances chimiques
Urea
8W8T17847W
Creatinine
AYI8EX34EU
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
25779Informations de copyright
© 2024. The Author(s).
Références
Boerhaave, H. Elementa Chemiae: Qui Continet Operationes Chemicas (Sumptibus S.K.,1732).
Smith, H. W. The Kidney: Structure and Function in Health and Disease (Oxford University Press, 1951).
Bankir, L. & Yang, B. New insights into urea and glucose handling by the kidney, and the urine concentrating mechanism. Kidney Int. 81, 1179–1198 (2012).
doi: 10.1038/ki.2012.67
pubmed: 22456603
Klein, J. D., Blount, M. A. & Sands, J. M. Wiley,. Urea transport in the kidney. In Comprehensive Physiology 699–729. https://doi.org/10.1002/cphy.c100030 (2011).
Vanholder, R. et al. Uremic toxicity: present state of the art. Int. J. Artif. Organs 24, 695–725 (2001).
doi: 10.1177/039139880102401004
pubmed: 11817319
Sanaka, M., Kuyama, Y., Nishinakagawa, S. & Yamanaka, M. Age-specific diagnostic values of the blood urea nitrogen/creatinine ratio in distinguishing upper from lower gastrointestinal bleeding. J. Clin. Gastroenterol. 26, 151–152 (1998).
doi: 10.1097/00004836-199803000-00014
pubmed: 9563930
Witting, M. D. et al. (eds) ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am. J. Emerg. Med. 24, 280–285 (2006).
Morgan, D. B., Carver, M. E. & Payne, R. B. Plasma creatinine and urea: creatinine ratio in patients with raised plasma urea. BMJ 2, 929–932 (1977).
doi: 10.1136/bmj.2.6092.929
pubmed: 912370
pmcid: 1631607
Haines, R. W. et al. Catabolism in critical illness: a reanalysis of the reducing deaths due to oxidative stress (REDOXS) trial*. Crit. Care Med. 50, 1072–1082 (2022).
doi: 10.1097/CCM.0000000000005499
pubmed: 35220340
Haines, R. W. et al. Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma. Intens. Care Med. 45, 1718–1731 (2019).
doi: 10.1007/s00134-019-05760-5
Gunst, J., Kashani, K. B. & Hermans, G. The urea-creatinine ratio as a novel biomarker of critical illness-associated catabolism. Intens. Care Med. 45, 1813–1815 (2019).
doi: 10.1007/s00134-019-05810-y
Heyland, D. K. et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet 401, 568–576 (2023).
doi: 10.1016/S0140-6736(22)02469-2
pubmed: 36708732
Haines, R. W. et al. Association between urea trajectory and protein dose in critically ill adults: a secondary exploratory analysis of the effort protein trial (RE-EFFORT). Crit. Care 28, 24 (2024).
doi: 10.1186/s13054-024-04799-1
pubmed: 38229072
pmcid: 10792897
Aniort, J. et al. Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients. Crit. Care 20, 43 (2016).
doi: 10.1186/s13054-016-1225-5
pubmed: 26895760
pmcid: 4761179
Sato, T. & Kushimoto, S. Relationship between nitrogen loss and blood urea nitrogen concentrations in patients requiring continuous renal replacement therapy. Acute Med. Surg. 4, 75–78 (2017).
doi: 10.1002/ams2.219
pubmed: 29123839
Volbeda, M., Hessels, L., Posma, R. A., Bakker, S. J. & Nijsten, M. W. Time courses of urinary creatinine excretion, measured creatinine clearance and estimated glomerular filtration rate over 30 days of ICU admission. J. Crit. Care 63, 161–166 (2021).
doi: 10.1016/j.jcrc.2020.09.017
pubmed: 32994085
Khwaja, A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin. Pract. 120, c179–c184 (2012).
doi: 10.1159/000339789
pubmed: 22890468
Meijer, A. J., Lamers, W. H. & Chamuleau, R. A. Nitrogen metabolism and ornithine cycle function. Physiol. Rev. 70, 701–748 (1990).
doi: 10.1152/physrev.1990.70.3.701
pubmed: 2194222
Béchet, D., Tassa, A., Combaret, L., Taillandier, D. & Attaix, D. Regulation of skeletal muscle proteolysis by amino acids. J. Ren. Nutr. 15, 18–22 (2005).
doi: 10.1053/j.jrn.2004.09.005
pubmed: 15648001
Bilancio, G. et al. Effects of bed-rest on urea and creatinine: correlation with changes in fat-free mass. PLoS ONE 9, e108805 (2014).
doi: 10.1371/journal.pone.0108805
pubmed: 25265226
pmcid: 4181864
Preiser, J. C., Ichai, C., Orban, J. C. & Groeneveld, A. B. J. metabolic response to the stress of critical illness. Br. J. Anaesth. 113, 945–954 (2014).
doi: 10.1093/bja/aeu187
pubmed: 24970271
Hawkins, R. B. et al. Chronic critical illness and the persistent inflammation, immunosuppression, and catabolism syndrome. Front. Immunol. 9 (2018).
Mira, J. C. et al. Sepsis pathophysiology, chronic critical illness, and persistent inflammation-immunosuppression and catabolism syndrome. Crit. Care Med. 45, 253–262 (2017).
doi: 10.1097/CCM.0000000000002074
pubmed: 27632674
pmcid: 5243156
Gruther, W. et al. Muscle wasting in intensive care patients: Ultrasound observation of the M. quadriceps femoris muscle layer. J. Rehabil. Med. 40, 185–189 (2008).
doi: 10.2340/16501977-0139
pubmed: 18292919
Puthucheary, Z. A. et al. Acute skeletal muscle wasting in critical illness. JAMA 310, 1591 (2013).
doi: 10.1001/jama.2013.278481
pubmed: 24108501
Jung, B. et al. Sepsis is associated with a preferential diaphragmatic atrophy. Anesthesiology 120, 1182–1191 (2014).
doi: 10.1097/ALN.0000000000000201
pubmed: 24608360
Fazzini, B. et al. The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis. Crit. Care 27, 2 (2023).
doi: 10.1186/s13054-022-04253-0
pubmed: 36597123
pmcid: 9808763
Pesola, G. R., Akhavan, I. & Carlon, G. C. Urinary creatinine excretion in the ICU: low excretion does not mean inadequate collection. Am. J. Crit. Care 2, 462–466 (1993).
doi: 10.4037/ajcc1993.2.6.462
pubmed: 8275151
Khan, J., Bath, K., Hafeez, F., Kim, G. & Pesola, G. R. Creatinine excretion as a determinant of accelerated skeletal muscle loss with critical illness. Turk. J. Anesth. Reanim. 46, 311–315 (2018).
doi: 10.5152/TJAR.2018.60437