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The utility of the creatinine excretion to production ratio and the plasma creatinine and cystatin C based kinetic estimates of glomerular filtration rates in critically ill patients with sepsis

 Department of Anaesthesiology and Critical Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia

Correspondence Address:
Azrina Md Ralib,
Department of Anaesthesiology and Intensive Care, International Islamic University Malaysia, Bandar Indera Mahkota, 25200 Kuantan, Pahang
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.ijn_519_21

Introduction: Creatinine kinetics denotes that under steady-state conditions, creatinine production (G) will equal creatinine excretion rate (E). The glomerular filtration (GFR) is impaired when excretion is less than production. The kinetic estimate of GFR (keGFR) and E/G ratio were proposed as a more accurate estimate of GFR in acute settings with rapidly changing kidney function. We evaluated keGFR and E/G to diagnose AKI, predict recovery, death or dialysis. Methods: This is a prospective observational study of critically ill patients. Inclusion criteria were patients >18 years old with sepsis, defined as clinical infection with an increase in SOFA score >2, and plasma procalcitonin >0.5 ng/mL. Plasma creatinine and Cystatin C were measured on ICU admission and 4 h later, and their keGFR was calculated. Urine creatinine and urine output were measured over 4 h to calculate the E/G ratio. Results: A total of 70 patients were recruited, of which 49 (70%) had AKI. Of these, 33 recovered within 3 days, and 15 had a composite outcome of death or dialysis. Day 1 keGFRCr and keGFRCysC discriminated AKI from non-AKI with AUCs of 0.85 (95% Confidence interval: 0.74–0.96), and 0.86 (0.76–0.97), respectively. The E/G ratio predicted AKI recovery (AUC: 0.81 (0.69–0.97)). The keGFRs were not predictive of death or dialysis, whereas E/G was predictive (AUC: 0.76 (0.63–0.89). Conclusion: keGFR was strongly diagnostic of AKI. The E/G ratio predicted AKI recovery and a composite outcome of death and dialysis.

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