Time courses of urinary creatinine excretion, measured creatinine clearance and estimated glomerular filtration rate over 30 days of ICU admission

• Published in: Journal of critical care Vol. 63; pp. 161 - 166
• Main Authors: Volbeda, M., Hessels, L., Posma, R.A., Bakker, S.J., Nijsten, M.W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2021; Elsevier Limited
• Subjects: Creatinine; Creatinine clearance; Critical care; Females; Glomerular filtration rate; Males; Mortality; Muscle mass; Muscle wasting; Patients; Plasma; Regression analysis; Sarcopenia; Sexes; Urea:Creatinine ratio; Urinary creatinine excretion; Urinary urea excretion; Urine; Creatinine; eGFR; Urinary urea excretion; Creatinine clearance; UUE; Muscle wasting; CI; Urinary creatinine excretion; IQR; mCC; MDRD; Glomerular filtration rate; Urea:Creatinine ratio; Sarcopenia; BSA; LOS; UCE; ICU; CKD-EPI; Muscle mass; APACHE; AKI
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.09.017

Baseline urinary creatinine excretion (UCE) is associated with ICU outcome, but its time course is not known. We determined changes in UCE, plasma creatinine, measured creatinine clearance (mCC) and estimated glomerular filtration (eGFR) in patients with an ICU-stay ≥30d without acute kidney injury stage 3. The Cockcroft-Gault, MDRD (modification of diet in renal disease) and CKD-EPI (chronic kidney disease epidemiology collaboration) equations were used. In 248 patients with 5143 UCEs hospital mortality was 24%. Over 30d, UCE absolutely decreased in male survivors and non-survivors and female survivors and nonsurvivors by 0.19, 0.16, 0.10 and 0.05 mmol/d/d (all P < 0.001). Relative decreases in UCE were similar in all four groups: 1.3, 1.4, 1.2 and 0.9%/d respectively. Over 30d, mCC remained unchanged, but eGFR rose by 31% (CKD-EPI) and 73% (MDRD) and creatinine clearance estimated by Cockcroft-Gault by 59% (all P < 0.001). Over 1 month of ICU stay, UCE declined by ≥1%/d which may correspond to an equivalent decline in muscle mass. These rates of UCE decrease were similar in survivors, non-survivors, males and females underscoring the intransigent nature of this process. In contrast to measured creatinine clearance, estimates of eGFR progressively rose during ICU stay. [Display omitted] •We measured changes in urinary creatinine excretion (UCE) in 248 patients with an ICU stay of ≥30 days.•UCE decreased by ≥1% per day, regardless of survival status.•Measured creatinine clearance derived from UCE remained stable over 1 month.•Plasma creatinine based estimates of renal function steadily rose, showing poor accuracy in prolonged critically ill patients