【罂粟摘要】使用碘海醇血浆清除率来评估肾肌酐清除率增高的危重患者的肾小球滤过率：一项单中心回顾性研究

使用碘海醇血浆清除率来评估肾肌酐清除率增高的危重患者的肾小球滤过率：一项单中心回顾性研究

翻译：佟睿    编辑：佟睿    审校：曹莹

贵州医科大学高鸿教授课题组

背景

肾肌酐清除率增加(≥130ml min^-11.73m^-2)在重症监护病房(ICU)患者中很常见，可能会影响患者的预后。

目的

比较肾清除增加的危重病患者碘海醇血浆清除率与肌酐清除率测量的肾小球滤过率(GFR)。

试验设计

单中心，回顾性研究。

受试人群

进行了碘海醇血浆清除率测定的肾清除率增加的成年患者。

主要观察指标

6h肌酐清除率(6h CrCl)和碘海醇血浆清除率(GFRio)之间的一致性。

结果

本试验共纳入29名患者。肌酐清除率中位数为195[四分位数范围(IQR)162~251]ml min^-11.73m^-2；碘海醇清除率为133[117~153]ml min^-11.73m^-2。碘海醇清除率测定的16例(55%)患者有高滤过(清除率>130ml min^-11.73m^-2)。碘海醇与肌酐清除率之间的平均偏差为-80[协议限值(LoA)-216~56min^-11.73m^-2]。Cockcroft和Gault修改肾脏疾病方程(MDRD)、慢性肾脏病流行病学协作方程(CKD-EPI)公式的平均偏差分别为27(LoA -99~45)、-14(LoA -86~59)和15(LOA -33~64)ml min^-11.73m^-2。

结论

在目前的研究中，我们发现在肾肌酐清除率增强的患者中，有一半的患者没有使用碘海醇清除率测量进行超滤。我们观察到6h CrCl和GFRio之间有一个重要的偏差，而且LoA很大。在ARC危重患者中，6h CrCl不能可靠地估计肾小球滤过率，6h CrCl几乎系统性高估了肾功能。基于肌酐的GFR估计和GFRio的比较显示可以接受的偏差，但存在广泛的LoA。

Evaluation of glomerular filtration rate using iohexol plasma clearance in critically ill patients with augmented renal creatinine clearance A single-centre retrospective study

Abstract

BACKGROUND Augmented renal creatinine clearance (ARC) (≥130ml min^-11.73m^-2) is frequent in intensive care unit (ICU) patients and may impact patient outcome.

OBJECTIVES To compare glomerular filtration rate (GFR) measured with iohexol plasma clearance and creatinine clearance in critically ill patients with augmented renal clearance.

DESIGN Single-centre, retrospective study.

SETTING French University Hospital ICU from November 2016 to May 2019.

PATIENTS Adult patients with augmented renal clearance who had a measurement of iohexol plasma clearance.

MAIN OUTCOME MEASURE Agreement between 6 h creatinine clearance (6 h CrCl) and iohexol plasma clearance (GFRio).

RESULTS Twenty-nine patients were included. The median 6 h creatinine clearance was 195 [interquartile range (IQR) 162 to 251] ml min^-11.73m^-2 and iohexol clearance was 133 [117 to 153] ml min^-11.73m^-2. Sixteen patients (55%) had hyperfiltration (clearance >130 ml min^-11.73m^-2) measured with iohexol clearance. Mean bias between iohexol and creatinine clearance was ?80 [limits of agreement (LoA) -216 to 56 ml min^-11.73m^-2]. For Cockcroft and Gault Modification of Diet in Renal Disease equation (MDRD), Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) formulae, mean biases were, respectively -27 (LoA -99 to 45), -14 (LoA -86 to 59) and 15 (LoA -33 to 64) ml min^-11.73m^-2.

CONCLUSION In the present study, we found that in patients with augmented renal creatinine clearance, half of the patients do not have hyperfiltration using iohexol clearance measurements. We observed an important bias between 6 h CrCl and GFRio with large LoA. In critically patients with ARC, 6 h CrCl does not reliably estimate GFR and 6 h CrCl nearly systematically overestimates renal function. Comparison of creatinine-based GFR estimations and GFRio show acceptable bias but wide LoA.