Development of glomerular filtration rate monitor based on creatinine kinetic modelling in critically ill patients

Md Ralib, Azrina and Mat Nor, Mohd Basri and Mohamed, Rozilah @ Abdul Hadi and Abdullah, Nor Zamzila and Jamaludin, Ummu Kulthum and Dzaharudin, Fatimah (2018) Development of glomerular filtration rate monitor based on creatinine kinetic modelling in critically ill patients. UNSPECIFIED. UNSPECIFIED. (Unpublished)

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Abstract

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.

Item Type:	Monograph (UNSPECIFIED)
Additional Information:	67922/3934
Uncontrolled Keywords:	glomerular filtration, creatinine kinetic modelling,critically ill patients
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User:	Prof Azrina Md Ralib
Date Deposited:	11 Jan 2019 11:48
Last Modified:	12 Apr 2022 10:57
URI:	http://irep.iium.edu.my/id/eprint/67922

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