Overestimation of Glomerular Filtration Rate among Critically Ill Adults with Hospital-Acquired Oligoanuric Acute Kidney Injury

Erin N. Frazee, Heather A. Personett, Christina M. Wood-Wentz, Vitaly D Herasevich, John C Lieske, Kianoush B. Kashani

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: Medication use in the intensive care unit (ICU) depends on creatinine-based glomerular filtration rate (GFR) estimates. Urine output deterioration may precede the creatinine rise resulting in delayed recognition of GFR reductions. Our objective was to quantify the disparity between estimated GFR (eGFR) and true GFR in ICU patients with hospital-acquired oligoanuric acute kidney injury (hAKI). Methods: This single-center cohort study examined adults who met the Acute Kidney Injury Network stage III urine output criterion ≥48 hours after ICU admission. True GFR was ≤15 mL/min/1.73 m2, and eGFR was described by 6 different creatinine-based equations. True GFR and eGFR were compared on the day of hAKI diagnosis and followed for 4 days using multivariable linear regression with generalized estimating equations, adjusting for day and method. Results: Of the 691 patients screened, we enrolled 61 patients. After adjustment for multiple comparisons and day, there were significant differences in eGFR between the estimation methods and true GFR (P 2 and overestimation persisted through the fourth day of hAKI (P ≤.001). Conclusion: Creatinine-based equations overestimated GFR in ICU patients with hAKI. This study highlights a population at risk of medication misadventures in whom systems optimization should be considered.

Original languageEnglish (US)
Pages (from-to)125-131
Number of pages7
JournalJournal of Pharmacy Practice
Volume29
Issue number2
DOIs
StatePublished - Apr 1 2016

Keywords

  • anuria
  • creatinine clearance
  • critical illness
  • glomerular filtration rate
  • renal failure

ASJC Scopus subject areas

  • Pharmacology (medical)

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