Introduction: Accurate assessment of renal function in the critically ill is important for diagnostic and prognostic performance. It is usually estimated from various estimate glomerular filtration rate (eGFR) equations. We evaluated eGFR based on Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) from serum creatinine (SCr), serum cystatin C (SCysC), and its combination, against 24-hour creatinine clearance (CrCL) to find the most accurate, precise, and less biased equation for GFR estimation.
Methods: Critically ill patients, older than 18 years who stayed longer than 24-hours were included. Urinary creatinine, SCr, and SCysC were measured at three-time intervals (8, 24, and 72-hour). After estimating GFR from SCr(eGFRCr), SCysC, (eGFRCysC) and combined CKD-EPI (eGFRCr-CysC), results were compared with CrCL.
Results: A total of 43 patients were recruited. eGFRCr had the highest correlation to CrCL, with correlation of 0.81 and 0.73 at 24 hrs and 72 hrs, respectively, and was the most precise and accurate equation compared to eGFRCysC and eGFRCr-CysC at all-time intervals. The bias was lowest in eGFRCysC equation. The Area Under Curve of eGFRCr in diagnosing acute kidney injury (AKI) was 0.93 and 0.84 at 24 and 72 hours, respectively. Neither CKD-EPI equations nor CrCL played a role in the prediction of in-hospital mortality with p>0.05 at all-time points.
Conclusion: eGFRCr had the highest correlation to CrCL and was the most accurate and precise equation, however, eGFRCysC had lowest bias at all-time intervals. Most of the equations contributed to the diagnosis of AKI. However, none on contributed to prediction of in-hospital mortality.
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